Threshold

Facet Joint Injections

Facet joint injections are NOT routinely funded for patients with chronic non-specific back pain. 

Facet joint injection for the treatment of suspected facet joint pain will be limited to ONE treatment episode per affected area of the spine only where this is recommended as part of a comprehensive pain management assessment and where the following conditions are met:

1. The patient is over 18 years or over

AND 

2. The pain has resulted in documented severe impact on daily living as assessed using the Oswestry Disability Index (>40% score)
3. All available conservative management options such as orthopaedic triage, advice and information, physiotherapy treatments, guided exercise programmes, weight management support and pharmacotherapy including analgesia and muscle relaxants have been considered and are being tried as appropriate, as part of a comprehensive pain management assessment 

AND

4. A pain specialist has assessed the patient and is of the opinion that no other treatment option is available for the patient

OR

5. Alternative treatments such as analgesic medication are intolerable or produce undesirable side effects 

OR

6. The patient has demonstrated failure to respond to, or had a loss of response to other treatment options.

Radiofrequency Denervation

Radiofrequency denervation facet joint medial branch procedures are limited to ONE per year, per area of the spine for patients who meet ALL of the following criteria:

1. The patient is aged 18 years or over

AND

2. The patient has moderate to severe levels of localised back pain assessed by a pain specialist using a validated scale (i.e. >40% on the Oswestry or Neck Disability Index)

AND

3. Back or neck pain predominates over leg pain or arm pain

AND

4. The patient has had a comprehensive pain management assessment and all available conservative management options such as advice and information, physiotherapy treatments and guided exercise programs, pharmacotherapy including analgesia and muscle relaxants have been considered and are being tried 

AND

5. A pain specialist has assessed the patient and is of the opinion that the main source of pain comes from structure supplied by the medial branch that supply the facet joints

AND

6. A diagnostic medial branch or intra-articular block, (facet joint injection) provided under a standard protocol, resulted in symptom relief pharmacologically and physiologically consistent with pain arising from structures innervated by the medial branch

NB: Imaging should not be offered for people with low back pain with suspected facet joint pain as a prerequisite for radiofrequency denervation.

For the purpose of this policy, a radiofrequency denervation procedure may consist of one or more denervations during a single visit. 

Repeat Radiofrequency Denervation

The patient must meet all the following criteria to be considered for repeat (consecutive) procedures:

1. Documented evidence of >50% pain relief and improved function over four months after the previous procedure using a validated tool  

AND

2. The patient progress along their individual pain management pathway has been reviewed by a pain specialist prior to each denervation procedure.
3. Repeated denervation of any previously treated facet joint has not been undertaken at less than 12 month intervals.

Further Facet Joint Injections for therapeutic purposes

Where Radiofrequency Denervation is inappropriate or contraindicated, further facet joint injections for therapeutic purposes are limited to no more than 2 injections in a year. The interval between injections should be at least six months. The patient must meet ALL the following criteria to be considered for repeated injections.

• Documented evidence of >50% pain relief

 AND 

• Improved function for over four months after the previous injection using a validated tool