Sacro-iliac Injections

For Management of Chronic Back Pain

Threshold

Norfolk and Waveney Integrated Care Board (ICB) will fund image-guided controlled SI joint injections for the management 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

AND

2)    The patient is suffering with non-radicular low back with duration of pain of at least 3 months

AND

3)    An 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

AND

4)   The pain has resulted in documented moderate to significant impact on daily functioning (a loss of physical function of 40% or greater as assessed by Oswestry Disability Index or similar)

AND

5)    No evidence of contraindications is present for the needle placement and injection of local anaesthetics.

Injections for diagnostic purposes

1. Patients may receive up to 2 diagnostic SI joint injections
2. A positive response is defined as 50% symptom reduction for 8 weeks and a second injection is only permitted based on such a positive response and therefore the patient will require:

• An appropriate pain/MSK review after 8 weeks has elapsed
• An interval greater than 8 weeks between the two injections.

Further SI Joint Injections for therapeutic purposes

If a patient has had a positive response to 1 or 2 diagnostic SI injections but symptoms persist, then radiofrequency denervation of the SI joint is funded.

Where Radiofrequency 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 or MSK clinician prior to each injection.

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for this intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.