Update to EBI policy (spinal injections amendment)
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Following a review of the NEL Evidence Based Intervention Policy in relation to spinal injections, it has become clear that the policy deviates from current NICE guidance on spinal injections. Therefore, NEL ICB is issuing an amendment to the policy which all providers should note. The changes are detailed below:
| Procedure and current NICE guidance | Current EBI policy | Updated Guidance |
| Epidural/nerve root injections NICE: To be administered only for acute (under three months) and severe sciatica | Nerve root injections are funded for pain lasting more than three months, and for up to three a year. There is no requirement for physiotherapy or other treatments before repeating another injection | Nerve root injections are for acute pain (under three months) and for severe sciatic pain only. A maximum of 2 injections per year are permitted, with updated criteria (see policy) for acceptance of funding. For a second procedure to be funded within 12 months, prior approval is required. |
| Medial Branch Block injection NICE: To be used as a diagnostic tool if the person has pain thought to be from the medial branch blocks, and the pain is local to the back when non-surgical treatment has not helped. | The EBI policy is written correctly, compliant with NICE, but medial branch block injections appear to be being repeated and used therapeutically. | Medial branch block injections can be used as a diagnostic tool to establish whether the person is likely to respond to radiofrequency denervation i.e. medial branch blocks are diagnostic and not therapeutic. They should not be repeated and administered in a pain management service. |
This amendment will ensure that patients receive evidenced based care, with equity of treatment that meets best practice. Thank you for your support in this matter.
The updated policy and approach to Prior Approval will become effective on 1 April 2025 and the policy will form part of any new or existing contract from that date.