Longer Not commissioned. WCCG will only commission an initial epidural injection for non-specific pain where: than 12 months Patients have actively participated in the decisions in respect of their treatment; Patients show commitment to taking responsibility for managing their condition by demonstrating relevant lifestyle changes, which include weight loss, increased fitness through exercise and physiotherapy; diet control, avoidance of illicit drugs and alcohol; improvement in sleep patterns; managing mood and mental health; and improved engagement in activities of daily living and purposeful occupation where appropriate; All other available conservative management options have been tried for at least twelve months and have proven to fail; Back or neck pain is rated at a level of 7/10 on the standard pain scale; Back or neck pain causes significant impact on daily functioning, which has been assessed using the HAD tool; and Patients have given their informed consent. WCCG will only fund a second epidural injection if: Six months have elapsed since the first injection and there is evidenced improvement, i.e. VAS (20mm reduction), HAD (reduction of 4 or more), Oswestry & EQ-5D scores showing improvement; as well as evidence of medication reduction at three months. In total, WCCG will only routinely fund a maximum of 2 epidural injections per patient. A request for exceptional funding must be made for a third injection at the same site.
Longer than 12 months Not commissioned. WCCG will only commission an initial epidural injection for non-specific pain where: Patients have actively participated in the decisions in respect of their treatment; Patients show commitment to taking responsibility for managing their condition by demonstrating relevant lifestyle changes, which include weight loss, increased fitness through exercise and physiotherapy; diet control, avoidance of illicit drugs and alcohol; improvement in sleep patterns; managing mood and mental health; and improved engagement in activities of daily living and purposeful occupation where appropriate; All other available conservative management options have been tried for at least twelve months and have proven to fail; Back or neck pain is rated at a level of 7/10 on the standard pain scale; Back or neck pain causes significant impact on daily functioning, which has been assessed using the HAD tool; and Patients have given their informed consent. WCCG will only fund a second epidural injection if: Six months have elapsed since the first injection and there is evidenced improvement, i.e. VAS (20mm reduction), HAD (reduction of 4 or more), Oswestry & EQ-5D scores showing improvement; as well as evidence of medication reduction at three months. In total, WCCG will only routinely fund a maximum of 2 epidural injections per patient. A request for exceptional funding must be made for a third injection at the same site.
20140501Spinal-Facet-Joint-and-Epidural-Injections-Policy-VERSION-3.3-Final-Approved.docx