What we looked at and why
Scottish Health Technologies Group (SHTG)
SHTG recommendation
In response to an enquiry from the Scottish Pain Medics National Network
What were we asked to look at?
We were asked to review the evidence on IV lidocaine infusions, spinal injections and radiofrequency ablation (RFA) for treating adults with chronic non-malignant pain. These interventions were selected in consultation with the Scottish Pain Medics National Network based on variation in practice across the National Health Service (NHS) in Scotland or uncertainty about the intervention’s clinical effectiveness.
Why is this important?
Living with chronic pain has a substantial impact on people’s quality of life and is a major cause of disability.1 In 2022, 38% of adults responding to the Scottish Health Survey reported experiencing chronic pain lasting more than 3 months.2 The Scottish Government recognises chronic pain as a complex long-term condition requiring a compassionate, comprehensive and targeted approach to management that acknowledges the reality of each person’s experience of pain, regardless of the cause.3
The Scottish Intercollegiate Guidelines Network (SIGN) guideline on chronic pain focuses on managing chronic non-malignant pain (pain lasting longer than 12 weeks) in adults in non-specialist healthcare settings that are not specifically designed for treating chronic pain.3 Currently, there are no Scottish guidelines on specialist treatments for people with chronic pain that persists despite non-specialist interventions. The specialist interventions available to patients vary between NHSScotland board areas leading to inequities in care (Dr L Williams, Consultant in Anaesthesia and Pain Medicine, NHS Greater Glasgow and Clyde. Personal communication, 27 November 2023).
What was our approach?
We reviewed the published literature on the clinical effectiveness, cost effectiveness, safety and patient experience of IV lidocaine infusions, spinal injections and RFA for treating adult patients who have chronic non-malignant pain. A patient organisation submission was sought from the Scottish Cross-Party Group on Chronic Pain. More information about SHTG Recommendations is available on our website.
What next?
The Scottish Pain Medics National Network will consider our recommendations in conjunction with the Scottish Government’s chronic pain management task force to inform the provision of specialist interventions for adult patients with chronic non-malignant pain across Scotland.