Hospital Dr News

GIRFT report on back pain calls for short-term pain relief to be replaced with rehabilitation

Replacing short-term pain relief injections with long-term physical and psychological rehabilitation programmes could help tens of thousands more patients cope with debilitating back pain, according to a new Getting It Right First Time (GIRFT) report on spinal surgery.

Lower back or radicular pain (sciatica) is the primary cause of disability in the UK. It affects one-third of the population at any one time, and 84% of people in their lifetime.

The latest GIRFT national report found that, despite NICE guidance, a significant number of patients are still receiving facet joint injections (injections of local anaesthetic and/or steroids to block pain), which have limited clinical value. On average between 2015 and 2018, almost 6% of patients with back pain received three or more facet joint injections in a year, at a cost to the NHS of £10.5m.

Reinvesting this money in longer-term physical and psychological rehabilitation programmes – close to patients’ homes – is one of the key recommendations in the GIRFT report. This is in line with the National Low Back and Radicular Pathway, endorsed by NICE.

The spinal surgery national report – the eighth from the Getting It Right First Time programme –focuses on spinal emergency conditions such as spinal cord injury and spinal infection, in addition to the management of common conditions such as back and radicular pain (sciatica). It shows that in 2017/18 the NHS carried out 52,523 surgical procedures on the spine.

A series of 22 recommendations bring opportunities to improve the patient experience through earlier discharge from hospital, reducing cancelled operations and ensuring trusts are equipped to deliver the best care in the most-timely manner. It is estimated the recommendations could deliver cost efficiencies of up to £27m.

Among the recommendations in the report are:

  • Referral without delay to 24-hour MRI scanning in all hospitals for patients with suspected cauda equina syndrome (a spinal emergency which can lead to limb paralysis and permanent loss of bowel and bladder function if not treated quickly);
  • All major trauma centres to have the ability 24/7 to stabilise and decompress the spine in patients with fractured and dislocated spines;
  • Suggested changes to the referral pathway of paediatric spinal deformity patients to enable children to be treated close to home where appropriate but at a centre with the shortest waiting time;
  • Better recording of implants, their use and patient outcomes.

The report’s author, Mike Hutton, a consultant spine surgeon at the Royal Devon & Exeter Hospital, visited 127 spinal units across England in his review.

Hutton said: “During my visits, I have been repeatedly struck by the passionate commitment of the clinical staff towards the NHS as a force for good in society. The majority of units expressed pride in their work, a sense of ownership of their unit and a loyalty to the communities they service. They do so, however, under significant increasing demand on their services and financial constraints.

“I am excited to put forward the recommendations in this report. I firmly believe they offer the potential to achieve significant improvements in patient care and to create significant financial opportunities.”

Professor Cliff Shearman, vice-president of the Royal College of Surgeons said: “Chronic back pain and spinal conditions can cause serious physical discomfort and be very distressing for patients.

“The Royal College of Surgeons fully supports this GIRFT report, which makes recommendations on how the NHS can better manage patients with back pain and spinal conditions to improve their outcomes. We urge hospitals to read the report and examine whether they could enhance the treatment they offer patients with chronic back pain and spinal conditions.”

Read the full report.

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