An independent provider in the City of Nottingham area

3. Mr H complains the Trust and the Partnership gave him steroid injections despite him having a diagnosis of stenosis while under both its care for back pain from 2018. He also says both the Trust and the Partnership did not manage his pain correctly.

4. Mr H says both the Trust and Partnership were wrong to give him steroid injections with a diagnosis of stenosis as these will not work. He says he has gone from having three prolapsed discs to seven and has told us this is due to the poor standard of care he has received. He also says he is in constant pain, and his quality of life has deteriorated due to this. He wants an acknowledgement of failings and a financial remedy.

5. Mr H had a history of back pain from 2015 and received a diagnosis of stenosis from another organisation in early 2018. He then attended the pain services at the Trust and Partnership from May 2018 where it provided him with pain relief injections and treatment until May 2021.

8. Mr H complains that the Trust and the Partnership gave him steroid injections despite him having a diagnosis of stenosis while under its care for back pain from 2018. He also says it did not manage his pain correctly.

9. Mr H told us that in March 2023, he had a consultation with a spinal practitioner who went through the whole history of his back pain with him and told him the steroid injections that he previously had in 2018 would not work due to his diagnosis of stenosis. He said this has caused him concern about what the Trust and Partnership has done since 2018. We can see from what he told us why this later advice caused Mr H worry and led him to question whether earlier treatment had been appropriate.

10. We have made the decision to look at the concerns raised about both organisations at the same time as there appears to be a crossover of care during the period Mr H has told us about.

11. We have seen evidence which confirms that Mr H was diagnosed with stenosis by a separate organisation between May and August 2018.

12. Our clinical adviser explained that stenosis is a very common condition which can be mild, moderate or severe. They said symptoms usually include pain in the leg. The records show that Mr H was diagnosed with mild stenosis in 2018.

13. NICE guidance on chronic lower back pain says a practitioner should consider referral for assessment for radiofrequency denervation. This is heat from radio waves to disrupt nerves transmitting pain, providing temporary relief for chronic back pain, if the pain is thought to come from the small nerves around the joints in the spine. It says this treatment should only be offered if the person has first had a diagnostic medial branch block (MBB). This is a minimally invasive injection used to diagnose and temporarily relieve pain originating from spinal facet joints, and this has helped their pain.

14. Mr H was initially seen by the Trust in early May 2018 for lower back pain. Following this appointment, it referred him for an MBB in a pain clinic in line with the above NICE guidance. It appears Mr H had an MBB with another pain care provider (not part of the Trust or Partnership) in August. This pain care provider transferred his care to the Partnership who he first saw in early November. The Partnership then provided Mr H with a further MBB in mid-December. Afterwards, it recorded Mr H as saying he was feeling sixty percent pain relief, when standing and sitting. The Partnership then offered him radiofrequency denervation in line with the above NICE guidance, as he had now had an MBB, which he had in early 2019.

15. The radio frequency denervation did not improve Mr H’s pain, so the Partnership offered him a repeat magnetic resonance imaging (MRI) scan. Following this it sought a review from its spinal consultant in January 2020 who recommended Mr H for a caudal epidural injection to alleviate his lower back pain as a short-term solution while he considered a surgical option. The consultant also suggested that the Partnership rule out peripheral vascular disease (narrowed arteries that reduce blood flow to the lower limbs).

16. We can see Mr H was keen to have the caudal epidural injection which due to covid restrictions did not take place until early May 2021.

17. Having considered all the evidence, it appears the Trust and Partnership followed NICE guidance when it provided Mr H with first an MBB and then radio frequency denervation to manage his lower back pain from 2018 and to May 2021.

18. Our clinical adviser explained the presence of stenosis would not affect these injections, nor would the injections cause any progression in stenosis. They go on to say judgement at the time was that symptoms Mr H was experiencing were from other structures in the spine and not the stenosis itself which would have progressed due to its nature as it is a degenerative condition.

19. We hope he will be reassured that the treatment provided does not appear to have impacted the progression of his stenosis.

20. We have gone on to look at how the Trust and the Partnership managed Mr H’s pain during the same period.

21. NICE guidance on lower back pain says weak opioids are for short term back pain. It goes on to say for patients who are already on these drugs it is recommended a shared decision-making approach where balance of the risk and benefit for stopping these drugs is made. If the balance of risk and benefit is favourable, then the drugs can be continued if these have been discussed with the patient.

22. As stated earlier, we have seen evidence the Trust first saw Mr H in May, followed by further interventions from the Partnership from 2018 to mid-2021.

23. Alongside offering him MBB, radiofrequency denervation and a caudal epidural injection, we can see that the Trust and the Partnership considered his pain through discussions on his current medication. In early May, Mr H told the Trust that he had experienced pain relief from taking oxycodone (an opiate pain killer).

24. The Trust then wrote to his GP to recommend he continue a lower dose of this medication after having discussed the risks of taking oxycodone with Mr H during the appointment.

25. The Partnership then followed this with further discussions with Mr H in relation to his ongoing medication and pain relief during its involvement in his treatment later in 2018 until May 2021.

26. We therefore consider the Trust and Partnership acted in line with NICE guidance. Both organisations appear to have looked at treatment and medication to manage Mr H’s low back pain and taken account of his views about what pain relief was helping. They also appear to have shared ongoing decisions about pain relief and further treatment with his GP which appears to have been part of a shared decision-making approach.

27. We therefore do not consider the Trust and Partnership got anything wrong in the actions taken in relation to how they managed Mr H’s low back pain and we will take no further action on the complaint. We know this may not be the outcome Mr H hoped for, and we are sorry for any further disappointment our decision may cause.

28. We were sorry to hear of Mr H’s experience and recognise the difficulty he has as his physical health continues to deteriorate. We hope this will give him reassurances about what happened and why the Trust and Partnership took the actions they did relating to the management of his lower back pain during 2018.

1. We have carefully considered Mr H’s complaint about Nottingham University Hospitals NHS Trust (the Trust) and Nottingham City Care Partnership (the Partnership). We are sorry to hear Mr H has been facing challenges, including the deterioration in his physical health which impacts his daily life.

2. We have looked at the evidence provided to us by Mr H, the Trust and the Partnership and have seen that both organisations followed relevant guidance in the management of his lower back pain from 2018 to May 2021 and therefore, we will not be investigating the complaint further. We are sorry for any additional upset this may cause, and we hope our explanations below explain how we have fully considered this and give him some reassurances about what happened and why.