HNY Policy and Pathway Repository - North Lincolnshire

Low back pain with Sciatica

These interventions are commissioned if:

• the patient has radicular leg pain (below the knee for lower lumbar herniation, into the anterior thigh for upper lumbar herniation) consistent with the level of spinal involvement AND
• patient is in the early clinical course for symptom control AND
• clinician and patient reach agreement for therapeutic injection for moderate or severe lumbosacral radicular pain (compressive or inflammatory) AND
• alternative treatments are unsuitable or not tolerated (e.g. patient unfit for surgery/poorly defined surgical target/patient unable to tolerate neuropathic pain medications}.

 

Epidural injections are not commissioned for neurogenic claudication caused by central spinal canal stenosis.

 

Epidural injections are not commissioned for the treatment of non-specific low back pain.

Injection of depot preparations of steroid usually with local anaesthetic has an established value in a variety of acute and chronic pain problems associated with inflammatory, compressive or post-surgical pathology in the lumbosacral spine, where leg pain is the predominant symptom.

NG59 Management of low back pain and sciatica in over 16's

EBI Injections for non specific Low Back pain

Metanalysis

National Low Back and Radicular Pain Pathway