Injections for isolated lower back pain without sciatica

For the treatment of

Non-specific low back pain without radiculopathy

Commissioning position

The following interventions are not commissioned:

Spinal injections of local anaesthetic and/or steroid for non-specific low back pain.
Facet joint injections
Therapeutic medial branch blocks
Intradiscal therapy
Prolotherapy
Trigger point injections with any agent, including botulinum toxin
Epidural steroid injections for chronic low back pain or for neurogenic claudication in patients with central spinal canal stenosis
Any other spinal injections not specifically covered above

Radiofrequency denervation can be offered according to NICE guideline (NG59) if all non-surgical and alternative treatments have been tried and there is moderate to severe chronic pain that has improved in response to diagnostic medial branch block.

Epidural or nerve root block with local anaesthetic and steroid for patient with acute and severe lumbar radiculopathy is commissioned.

Summary of rationale

Spinal injections for treating low back pain without sciatica are not clinically or cost effective, except for people who meet the criteria for a procedure called 'radiofrequency denervation'.

To determine whether these people will benefit from this procedure, they may be offered a diagnostic block of the nerves that supply the joints between the vertebrae. If they experience significant pain relief, they may then be offered radiofrequency denervation to achieve longer-term relief.