Norfolk and Waveney CCGs will fund controlled SI joint injections for the diagnosis of SI joint pain when all the following criteria are met:
SI Joint Injections for diagnostic purposes
1) The patient has had a comprehensive multidisciplinary pain management assessment and all conservative management options (physiotherapy treatments and guided exercise programmes, pharmacotherapy including analgesia and muscle relaxants) have been tried and failed
2) The patient is suffering with non-radicular low back with duration of pain of at least 3 months
3) A MDT or a pain specialist or MSK Physician / GPSI (with back pain assessment, diagnostic and treatment skills) has assessed the patient and is of the opinion that a SI joint is the most likely cause of pain
4) The pain has resulted in documented moderate to significant impact on daily functioning (a loss of physical function of 50% or greater
5) No evidence of contraindications is present for the needle placement and injection of local anaesthetics.
1. Patients may receive up to 2 diagnostic SI joint injections 1 - 2 weeks apart. The second injection may only be given if the first elicits a positive response.
2. A positive diagnosis to a diagnostic injection is considered to be greater than 50% reduction in symptoms for at least eight weeks.
Further SI Joint Injections for therapeutic purposes
Where Radio frequency Denervation is inappropriate or contraindicated, further SI 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: AND
- The patient’s progress has been reviewed by a pain specialist prior to each injection.
- Radio frequency Denervation is inappropriate or contraindicated.
Patients with back pain secondary to spinal metastases are exempt from this policy.
|Latest change to document
||8 February 2018
||1 October 2018
|Next Review date