Category
Threshold Criteria
Non-radicular (none radiating) back pain is the commonest clinical presentation. Sometimes it is referred to as “mechanical back pain”. It is often the diagnosis for symptoms that are not caused by neural impingement or medically significant other causes.
The National Institute of Clinical Excellence (NICE) is clear in its guidance that intra-articular facet joint steroid injections should not be used in the treatment of pain originating from the lumbar facet joints. However, there are a few occasions where facet joint injections can be considered. These are detailed below.
In accordance with the LLR Back Pain Pathway all referrals will go through MSK triage and be assessed by a GP with Special Interests (GPwSI) or Enhanced Scope Physiotherapist.
Eligibility
| LLR ICB will fund medial branch blocks for the management of cervical, thoracic and lumbar back pain in the following clinical situations Diagnostic procedure leading to radiofrequency denervation of the medial branch if the diagnostic block is positive AND All conservative management options have been tried and failed – physiotherapy – exercise – pharmacotherapy including analgesia AND The pain has resulted in moderate to significant impact on daily life OR If the initial medial branch block has had a proven therapeutic benefit but the patient is not suitable for Radiofrequency Denervation or a Pain Management Programme (e.g. multiple comorbidities, cardiac and respiratory dysfunction, cardiac pacemaker or other nerve stimulator, or frail and elderly) |
| LLR ICB will fund facet joint injections in the following situations – In patients who have had a positive outcome from a previous injection – Elderly patients or those with comorbidities where positioning for radio frequency denervation is technically difficult – Patients who have significant anatomical problems where locating the nerve poses a risk to the patient |
Guidance
| ARP 71 Review Date:2026 |
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