Non-specific Back Pain Without Sciatica
Spinal injections of local anaesthetic and steroid should NOT be offered for patients with non-specific low back pain.
For people with non-specific low back pain the following injections should NOT be offered:
- Facet joint injections
- Therapeutic medial branch blocks
- Intradiscal therapy
- 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
Radio frequency 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 medical branch block.
Epidurals (local anaesthetic and steroid) should be considered in patients who have acute and severe lumbar radiculopathy at time of referral.
Alternative and less invasive options have been shown to work e.g. exercise programmes, behavioural therapy, and attending a specialised pain clinic. Alternative options are suggested in line with the National Back Pain Pathway.