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Tens of thousands of patients are given a 'useless' back-pain injection that costs the NHS nearly £40 million each year

Posted on 10/04/2018 by

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  • Patients demanding a 'quick fix' are given the treatment at £540 per procedure
  • Doctors are advised not to give the therapy but instead recommend exercise
  • Previous research suggests painkillers and rest are wrongly being prescribed
  • Such 'treatments' often slow patient recovery, with benefits being 'modest'
  • NHS bosses vowed to crack down on pointless treatments that cost £180 million

Tens of thousands of patients are being given a 'useless' back-pain injection, which costs the NHS nearly £40 million every year, an analysis suggests.

Patients that demand a 'quick fix' for their discomfort are being given the treatment, priced at £540 per procedure, despite doctors being told to recommend back-pain sufferers be more active or try psychological therapy.

This comes after research released last month suggested many patients are needlessly being prescribed strong painkillers, wrongly told to rest or even undergoing unnecessary surgery in a bid to treat lower-back pain.

According to Professor Martin Underwood, from Warwick University, who led the research, such 'treatments' often slow patient recovery, with any benefits being 'modest at best'.

Yesterday, health-service bosses vowed to crack down on pointless back-pain treatments, with needless surgeries, scans and injections costing the NHS up to £180 million annually.

Lower-back pain affects at least four in five people at some point in their lives, with around one in five sufferers developing chronic discomfort lasting a year or more. 

Tens of thousands of patients are being given a 'useless' back-pain injection every year


Back pain may be psychological, research suggested in September 2017.

People over estimate their lower back discomfort, a study found.

Lead author Dr Tasha Stanton from the University of South Australia, said: 'People with chronic back pain and stiffness overestimated how much force was being applied to their backs.

'This suggests that feelings of stiffness are a protective response, likely to avoid movement.' 

The researchers analysed 15 people with chronic lower back pain who reported feelings of stiffness.

The study's participants rated their stiffness from 'not stiff at all' to the 'most stiff imaginable'.

These participants were compared against 15 volunteers without such complaints.

The researchers carried out three experiments. The first applied pressure to the spine to determine its stiffness.

In the second experiment, the participants received a force that they were asked to score.

The third experiment assessed whether adding sounds to the perception of pressure changed the participants' stiffness. 

Referring to the third experiment, Dr Stanton added: '[We] found that these feelings could be modulated using different sounds. 

'The feeling of stiffness was worse with creaky door sounds and less with gentle whooshing sounds.

'The brain uses information from numerous different sources including sound, touch, and vision, to create feelings such as stiffness.

'If we can manipulate those sources of information, we then potentially have the ability to manipulate feelings of stiffness. 

'This opens the door for new treatment possibilities, which is incredibly exciting.

'Doctors use injections 'as a way of getting someone out the door'  

According to an analysis of NHS data by The Times, 70,608 steroid injections into patients' facet joints, which make spines flexible, occurred last year, compared to 62,570 five years ago.

Guidelines released in both 2009 and 2016 advise against the procedure. 

Figures also show 8,044 operations that fuse spinal bones together were carried out last year, up from 7,224 between 2012 and 2013. 

Such surgery can benefit patients with specific conditions or injuries but is ineffective for general back pain. 

Mike Hutton, a consultant surgeon who leads an NHS project to help improve spinal units, said: 'Operating on back pain thought to be arising from facet joints or discs is not a good operation and probably costs the taxpayer a lot of money.

'Sometimes the clinician may be using this as a way of getting someone out the door if they have nothing else to offer.'

Mr Hutton went on to say patients' expectations are often too high, with them assuming doctors are capable of fixing any discomfort.

He adds people should be wary of undergoing risky spinal surgeries unless there is a strong chance it will benefit their symptoms.

GPs vary hugely in their back-pain approaches

Mr Hutton's project shows patients have widely different experiences when it comes to presenting to their GPs with back pain, with some being referred to a spinal surgeon straight away.

He believes this may be due to physical and psychological rehabilitation programmes, which have been proven to work, often being unavailable.

By cutting back on 'useless' steroid injections and surgeries, money could be invested into such programmes, Mr Hutton adds.

According to Rahul Seewal, a consultant in pain medicine, steroid injections may make patients feel better initially but fail to resolve any underlying problems.

Yet, such invasive procedures are still preferred by doctors over psychological approaches, he adds. 

NHS figures also show 10,906 'radiofrequency denervations', which burn away troublesome nerves, were carried out last year, compared to 9,023 between 2012 and 2013. 

According to NICE, this procedure should be a last resort.

Speaking of the findings, Julie Wood, chief executive of NHS Clinical Commissioners, which represents bodies that fund care in England, the NHS Clinical Commissioners is in discussions with NHS England to create guidelines supporting the most cost-effective back-pain remedies.


Being highly active reduces the risk of chronic lower-back pain by 16 per cent, research suggested in July 2017.

Regular moderate activity lowers the risk of such discomfort by 14 per cent, a study review found.

Yet, exercise has no impact on short-term back pain or that which causes hospitalisation or disability, the research adds.

Dr Joel Press, physiatrist-in-chief at the Hospital for Special Surgery in New York, who was not involved in the study, said: 'We were meant to move. We were not meant to be stagnant in any way.

'Generally lower impact, walking type things are probably the starting point. 

'Swimming is another low-impact activity that puts less load on your back'. 

Dr Press advises back-pain sufferers avoid sports that involve a lot of twisting and turning, such as golf and tennis. 

The researchers, from the Finnish Institute of Occupational Health in Helsinki, analysed data from 36 studies that included a total of 158,475 people.

The studies' participants did not have back pain at the start of the investigations.

Physical activity was defined as sport and intentional exercise, as well as walking and climbing stairs.

The participants were considered active if they engaged in physical activity at least twice a week for a minimum of 60 minutes.  

Yoga and massage are more effective than painkillers 

Research released last month shows simple exercises and stretches are more effective at easing back pain than analgesics.

Professor Underwood said: 'Our current treatment approaches are failing to reduce the burden of back-pain disability. 

The researchers reviewed evidence from both high and low-income countries around the world to build up a global picture of the extent of the back-pain problem and how it was being managed. 

They concluded lower-back pain is the world’s leading cause of disability but is often treated using aggressive approaches that have not been shown to work. 

NICE advises people with back pain be prescribed exercise, drugs such as ibuprofen, or both at the same time.

Yet growing evidence shows painkillers are largely ineffective and can do more harm than good, with massage, exercise and yoga being preferable.

Previous studies have shown opioid painkillers, which are prescription drugs that include morphine, tramadol and oxycodone, provide only ‘minimal benefit’ for lower-back pain.

Yet, recent figures estimate they are still prescribed to around 40 per cent of back-pain patients. 

Steve Tolan, head of practice at the Chartered Society of Physiotherapy, said doctors are too quick to medicalise treatments.

He said: ‘That so many people start out with minor back pain and go on to suffer life-changing consequences is bad enough. 

‘That healthcare professionals contribute to that journey is unconscionable.’  

You should always rest a bad back.

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