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GIRFT spinal report recommendation supported by study in European journal

A new study has found there are no sustained positive outcomes for low back pain from the use of multiple spinal injections, supporting a recommendation made in the 2019 Getting It Right First Time (GIRFT) spinal services report.

The study, titled Multiple injections for low back pain: What’s the future?, and published in the European Spinal Journal, confirms the GIRFT position that short-term pain relief injections should be replaced with long-term physical and psychological rehabilitation programmes to help tens of thousands more patients cope with debilitating back pain.

Examining the strength of evidence available for facet joint injections (FJIs) and medial branch blocks (MMBs), the study reported on the variations in the NHS England framework using GIRFT data and provided a systematic review and literature search using Cochrane, MEDLINE and EMBASE databases. The GIRFT data used in the study was part of the GIRFT spinal services report, published in January 2019 and written by consultant spine surgeon Mike Hutton. The GIRFT report focused on spinal emergency conditions, such as spinal cord injury and spinal infection, in addition to the management of common conditions such as back and radicular pain (sciatica).

The new study, authored by Oluwatobi Onafowokan, Nicola Fine, Francis Brooks, Oliver Stokes, GIRFT chair Professor Tim Briggs and Mr Hutton, examined the use of multiple injections for low back pain and found no sustained positive outcomes at long term follow up. It also found a high degree in variation in the use of multiple FJIs, which cost the NHS £10.5m a year.

The study concluded that there is a lack of evidence available for the effectiveness for FJI and MBBs in treating lower back pain. It supports GIRFT findings that FJIs are still being widely used despite lack of support by UK and US guidelines and lack of evidence supporting their use. It also concluded that there is low quality evidence supporting use of MBBs for the long term management of low back pain and poor evidence supporting the use of repeat injections.

Lower back or radicular pain is the primary cause of disability in the UK. It affects one-third of the population at any one time, and 84% of people in their lifetime. GIRFT’s data shows that on average, 5.7% of patients receive three or more facet joint injections in a year, costing the NHS £10.5m.

To read the GIRFT spinal report, click here

1 February 2020