A new study published in an international spine journal shows that the number of patients in England having repeat lumbar injections for back pain has significantly reduced, in line with a key recommendation in Getting It Right First Time’s 2019 national report for spinal services.

The study – entitled Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England – is the work of a group of GIRFT clinicians and is published in the Global Spine Journal.

It shows a significant change in practice in the use of repeated lumbar facet joint injections or medial branch blocks in England in the period from April 2015 to March 2021; of more than 134,000 patients receiving the pain-blocking injections, only around 6.6% (around 9,000) had two within 180 days or three within a year. First injections fell from around 42,500 in 2015/16 to around 13,500 in 2019/20 and repeat injections fell from around 4,000 to just 424 in the same period.

GIRFT’s national report for spinal services (early 2019) found that. in spite of NICE guidance advising against the practice. a significant number of patients were still receiving facet joint injections, which have limited clinical value. GIRFT’s review of services highlighted that patients receiving three or more facet joint injections in a year cost the NHS around £10.5m. Reducing the use of repeat facet joint injections or medial branch blocks and reinvesting that money in longer-term physical and psychological rehabilitation programmes – close to patients’ homes – was one of the key recommendations in the GIRFT report.

The Global Spine Journal study found that financial cost of injections reduced from £27.6 million in 2015/16 to £7.9 million in 2019/20. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the five years, enough to power 2,575 average UK homes for a year.

The study concludes that while the number of patients having repeated injections has fallen over time, they have not been eliminated and further work is needed to educate patients and clinicians on alternative and more effective treatments.

The GIRFT team conducting the study was:

• Elizabeth Ojelade, Jacob Koris and Maria Van-Hove: GIRFT Fellows
• William Gray: GIRFT’s academic content lead
• Professor Tim Briggs: Chair of GIRFT and NHS England National Director for Clinical Improvement and Elective Recovery
• Mike Hutton: GIRFT clinical lead for spinal services and author of the 2019 national report.