BackCare

No painkilling injections on NHS

04 Aug 2009

Pain specialists argue that the NHS not paying for painkilling injections will leave patients living in pain.

According to a story published in the Sunday Telegraph on 2 August 2009 many doctors believe that as a consequence of the new NICE guideline on treating low back pain, many patients will be left in agonising pain as they will find it much more difficult to get painkilling injections on the NHS.

The guideline issued by NICE in May advises that the use of therapeutic injections of steroids, such as Cortisone, to reduce inflammation and pain should not be offered to people suffering from persistent low back pain of an unspecific cause, lasting between six weeks to a year. Instead such patients should be offered treatments such as acupuncture, manual therapy which includes physiotherapy, osteopathy and chiropractic and exercise. Patients who have back pain attributed to a specific cause lasting longer than one year are not covered by this guideline. However, many specialists disagree with the guidance and believe that it will result in many back pain patients, especially the elderly and frail, having to live in excruciating pain or paying upwards of £500 to receive injections in the private sector.

Steroid injections work by reducing inflammation and therefore pain while other types of injections can deaden nerve endings and can provide months if not years of relief from pain. At present the NHS issues approximately 60,000 steroid injection treatments a year, but NICE suggests that this be cut to just 3,000. However this decision has been extremely controversial and as a result more than 50 pain specialists have written to NICE asking them to reconsider their decision. They argue that the guideline will mean more people will begin taking addictive and potentially dangerous opioids for their pain. The British Pain Society which is a body that represents specialists in the pain management field have written to NICE asking for the withdrawal of the guideline with members claiming that this guideline would also result in too many patients undergoing unnecessary, risky spinal surgeries. Many patients also feel let down by the guidelines. Eighty-year-old Iris Watkins said her life had been "transformed" by the use of therapeutic injections. "I was referred to a specialist, who decided to give me a set of injections,” she said. “The difference was tremendous".

NICE do admit that the evidence for back pain treatments, even the ones they do advocate, is limited. However, its expert group were able to help give them advice where scientific evidence was lacking. This also angers pain experts who argue that the expert group did not include anyone with expertise in conventional pain relief medicine. The anger caused by this guideline has reached such a level that Dr. Paul Watson, a physiotherapist and President of the British Pain Society was forced to resign as a result of his involvement in helping draft the guideline. NICE chairman Professor Sir Michael Rawlins responded to this by describing the actions of the society as “shameful” and accusing pain specialists of not accepting that there is insufficient scientific evidence for the efficacy of pain injections. NICE  have also responded to the criticism by stating that the guideline does not recommend that injections not be given, it simply states that they are not recommended for patients who have back pain of unknown or non-specific cause which has lasted less that a year.

BackCare as an independent charity understands the views held by some members of the healthcare profession and back pain sufferers. However, we do believe that the NICE guideline is not advocating the removal of injections as a viable treatment option. Its scope is specific in that it doesn’t recommend injections for back pain with a non-specific or unknown cause lasting less that a year. However, for cases that fall outside this scope, where the pain has lasted longer than a year and the cause is identified, for example as caused by sciatica, then injection therapy may very well be an appropriate and beneficial treatment option.

To read the full story click here.