Scotland’s Pain Injections Survive September Without a National Rule

NHS Highland told patients in September 2026 that its chronic pain injection clinic was not scheduled to close. New patients are still barred from those injections, and ministers still will not implement February’s national evidence review.

About 1 in 5 people in Scotland live with pain that lasts more than 12 weeks. Kirstin Laing, a former nurse in Nairn, is one of them. She gets nerve root injections of steroid and local anaesthetic every four months for sciatic nerve damage, and she has spent a year asking what happens when the stopgap contract around that service runs out.

NHS Highland Did Not Shut the Service in September

The fear that ran through Highland pain clinics in 2025 was simple. Dr John Macleod, the consultant who built the board’s intervention service from 2009, had retired. The board stopped offering injections and infusions to new patients around 2021 and 2022, then paid him to keep treating some existing patients under a part-time deal due to end in September 2026.

On 8 September 2026 a board spokesperson said the service was not scheduled to close that month. Existing patients, the board said, continue to receive their injection interventions. Care and referral routes into the wider Chronic Pain Management Service stay the same. Secondary care consultants can still request the procedures inside NHS Highland.

The pain service itself still does not accept referrals for new injection interventions. That is the same split the board has run for four years: people already on the list keep the needle, and people who arrive now are steered toward therapy and “living well with pain.”

The board’s own service page, last updated on 7 September 2026, still lists Dr Macleod beside Dr Nancy Cox. It still publishes the Golspie numbers for Golspie anaesthetic interventions and lidocaine. A Faculty of Pain Medicine directory dated 24 September 2026 still names Lawson Memorial Hospital in Golspie for those theatre lists. The clinic is standing. The front door for new injection patients is not.

WHAT WE KNOW AND WHAT IS OPEN

• Still running: NHS Highland says existing patients keep injection interventions and the service was not scheduled to close in September 2026.
• Still closed: The Chronic Pain Management Service does not accept new referrals for injection interventions, a bar first put in place around 2021 and 2022.
• Still unsigned: The board says it is at an early stage of a review with clinicians and other stakeholders, with no final shape published.
• Still national: Holyrood has not told boards to follow February’s Scottish Health Technologies Group advice on these procedures.

Rhoda Grant, the Highlands and Islands Labour MSP, spent the spring warning that patients had been told the clinical pain intervention service would end in late September and that they would be sent to other boards. John Swinney, the first minister, told parliament in March that no final decision had been taken and that boards must consult before major changes. The September statement leaves that consultation, and that decision, still ahead of people who already wait months to be seen.

What the February Evidence Review Said

The Scottish Health Technologies Group published its advice on 27 February 2026 after clinicians on the Scottish Pain Medics National Network asked it to look at intravenous lidocaine, spinal injections and radiofrequency ablation. NHS Scotland is required to consider that advice. The group did not tell boards to scrap the procedures.

It said the treatments are not a cure and should sit inside a wider pain service, with a proper consent talk about short-lived relief and the thin evidence on repeating them for years. Then it said the following specialist interventions should be available for consideration across NHSScotland.

TREATMENTS THE REVIEW SAID BOARDS SHOULD OFFER

• Facet joint injections: Local anaesthetic with or without steroid for chronic pain that starts in the facet joints.
• Neck epidurals: Interlaminar epidural injections of local anaesthetic with or without steroid for chronic neck pain.
• Sacroiliac injections: Local anaesthetic plus steroid for chronic low back pain from the sacroiliac joint.
• Knee radiofrequency: Continuous radiofrequency ablation of the nerves that supply the knee.
• Sacroiliac radiofrequency: Continuous or cooled ablation for chronic sacroiliac joint pain.
• IV lidocaine: Infusions for chronic nerve pain when spinal injections or ablation are not the right tool.

On facet joints, a pooled look at 21 studies covering 2,370 people found pain scores fell for up to 12 months. Eight randomised trials in 587 people with facet joint osteoarthritis found about a 31% cut in pain scores and a 12.6% improvement in disability scores after six to 12 months. Adding steroid to anaesthetic did not change the result in the comparisons the group reviewed.

Lidocaine looks weaker as a long bet. A review of 27 studies in 358 people found a short drop in pain scores against placebo, often lasting hours or days, with light-headedness, fatigue and nausea the usual side effects. The group still said the infusion should be on the menu when targeted spinal procedures are not suitable.

Patient groups told the council that chronic pain tracks with a higher suicide risk, and that people who got lidocaine described being able to take children to school and go back to work. The same council noted that repeating infusions, injections or ablation would load waiting lists. Its answer was not a ban. It was a timely review after each procedure, and routine collection of pain, function and quality-of-life scores.

The group also recorded the reason it was asked. There are no Scottish guidelines on these specialist treatments, and what a patient can get already varies by board. That variation, it said, is inequity.

Ministers Passed the Decision Back to 14 Boards

Miles Briggs, the Conservative MSP for Edinburgh and Lothians East, asked on 9 September 2026 whether the government accepted that advice and why no implementation decision had come since 27 February. Maree Todd, the minister for mental wellbeing, public health, sport, alcohol and drugs, answered on 24 September 2026.

NHS Scotland is required to consider recommendations made by the Scottish Health Technologies Group (SHTG). That remains unchanged. It is not for the Scottish Government to consider or accept those recommendations made by the SHTG for NHS Scotland. NHS Boards are responsible for designing and delivering services to meet the needs of their local populations.

Maree Todd, Minister for Mental Wellbeing, Public Health, Sport, Alcohol and Drugs, written answer S7W-03067, 24 September 2026

That is the hinge. A publicly funded evidence body told NHS Scotland the injections not for the Scottish Government to accept should stay on the list. Seven months later the minister said the government does not sit in that chair. Boards must design the service. Boards have spent the same years waiting for a national line from the Pain Management Task Force, which has been meeting since 2022.

Jenni Minto, then public health minister, told Briggs in a June 2024 letter that pain patients would have to wait until 2026 for clarity. 2026 was an election year. The new parliament has sat since May. The written answer in September is the clarity: ministers will support partners to “build on” the recommendations. They will not instruct 14 boards to put the same six procedures on the same footing.

Highland had already used an “impending national review” as one reason to shut new patients out of injections in 2021 and 2022. The review has now landed, and it points the other way. The board’s answer is another review of its own. New patients remain outside the injection room while that work is described as early stage.

A Record 7,066 People Are Waiting

Public Health Scotland published the latest pain-service figures on 8 September 2026, covering the quarter ending 30 June 2026. Referrals rose. So did first appointments. The waiting list still grew to the highest number in the time series PHS has for this collection.

PAIN SERVICE ACTIVITY TO 30 JUNE 2026

Referrals were up 1.9% on the previous quarter and 1.8% on the year. First appointments were up 8.1% and 9.1%. The list still rose 3.7% in three months, to 7,066. PHS says boards had been pushing first appointments to meet the operational improvement plan target that, by the end of March 2026, no patient would wait more than a year for a new outpatient appointment, inpatient stay or day-case procedure.

Among people who were seen in the June quarter, 52.2% waited 12 weeks or less, down from a 55.2% average in 2025 and 57.9% in 2024. 8.3% of those seen had already waited 52 weeks or more, better than the 12.1% average in 2025 and worse than the 6.2% average in 2024. Those two percentages describe completed first appointments, not the people still in the queue.

Of the 7,066 still waiting on 30 June, 3.2% had already been there 52 weeks or more. That is 227 people. PHS names 67 of them in NHS Ayrshire and Arran, 57 in NHS Grampian and 99 in NHS Tayside. Vacancies, the loss of pain early information sessions in one board, recruitment trouble and waits for specialised clinics are the reasons boards gave.

Only 39.4% of those first appointments were with a medic. 26.4% were pain early information sessions, 13.5% a physiotherapist, 4.4% a nurse, 1.1% a multi-disciplinary clinic and 15.2% another clinician. On the waiting list, 45.6% were still queued for a medic. The expansion of first appointments is real. A large share of it is an information session or another non-medic contact, not a consultant with a theatre list.

Glasgow Offers a Fraction of What Tayside Delivers

The February review was commissioned because the same patient can be offered a lidocaine drip in one board and refused it in the next. Figures compiled for that review by the Scottish Cross-Party Group on Chronic Pain, from freedom of information replies, put a number on the gap.

NHS Greater Glasgow and Clyde, covering about 1.2 million people, recorded under five lidocaine infusions in a year, 570 injections and 112 radiofrequency treatments. NHS Tayside, with about 420,000 people, recorded 871 lidocaine infusions, 281 injections and 79 radiofrequency treatments. Glasgow’s biggest board has almost removed a treatment Tayside still runs at volume, and has concentrated what remains on two city hospitals, according to that submission.

Dorothy-Grace Elder, the former MSP who set up Holyrood’s cross-party group on pain in 2001 and lodged the patient-organisation paper, has argued that those cuts were made without asking patients. Some boards, including NHS Ayrshire and Arran in the replies she cites, said they stopped treatments for “clinical reasons” and had not asked patients first.

Highland sits in the same patchwork. It will still put a needle in at Golspie for people already on the books. It will not open that list to a new Highland patient with the same sciatica. Secondary care consultants can request the procedure, which is a back door, not a service specification. A patient in Dundee, Glasgow or Inverness is not on the same pathway, and February’s review has not forced those pathways to meet.

Patients Who Got Their Lives Back Are Still on a Clock

Laing has been in the Highland service since it started in 2009. After years bedridden with sciatic nerve damage, the four-monthly nerve root injections changed what she could do.

It was utterly life-changing. It was like having my leg back.

Kirstin Laing, former nurse, Nairn

In September 2026 she said that if the injections went, she and her husband would be back on morphine, and she would struggle to support him. The board’s 8 September statement keeps her on the existing-patient list for now. It does not tell the next woman in Nairn with the same nerve damage how to get the same injection. It does not tell Laing how long the “early stage” review will run, or whether her four-month cycle survives it.

Elder has described the waiting list as a hidden nightmare because the condition is incurable and the relief has no clean substitute. She told interviewers that withdrawing injections and infusions would pile people into A&E, and that about 40 people a year are taken off the waiting list because they have died. Ian Semmons of Action on Pain has called Scottish pain services probably the worst in the UK, with huge waits.

PHS does not publish a separate “died” reason for people removed from pain lists. Campaigners have for years documented patients dying while waiting for NHS pain clinics, and Elder’s cross-party group used that record in its submission to the February review. The official statistics show something adjacent: 2,434 people were removed from the pain waiting list in the June quarter for reasons other than being seen.

The people already getting injections are not the whole story. They are the group the system has decided it cannot ethically withdraw from. Everyone referred after the 2021 and 2022 cut in Highland, and everyone in a board that has already wound down lidocaine or theatre time, is in a different group. They are counted in the 7,066. They are not counted in Golspie’s theatre book.

Four Years of Review Have Not Produced a National Rule

The sequence is now long enough to read as a single delay, not a series of holding statements.

HOW THE DECISION WAS DEFERRED

1. 2021 to 2022: NHS Highland stops offering injections and other interventions to new chronic pain patients, citing evidence on long-term benefit and an impending national review, while keeping existing patients on anaesthetic interventions.
2. June 2024: The public health minister tells the cross-party group’s convener that patients will wait until 2026 for decisions on the fate of services.
3. 27 February 2026: The Scottish Health Technologies Group says the specialist interventions should be available inside NHSScotland pain services, with review after each treatment.
4. 18 March 2026: Grant says patients have been told the Highland intervention service will close in late September. The board says no decisions have been taken and a review is at a very early stage. The first minister says there is no final decision.
5. 7 to 8 September 2026: The Highland service page still lists Golspie. The board says the service is not scheduled to close. Public Health Scotland reports 7,066 people waiting, the highest figure in its current series.
6. 24 September 2026: Todd tells parliament that it is not for ministers to accept the February recommendations and that boards design the services.

On 30 September 2026, NHS Scotland’s Centre for Sustainable Delivery was promoting a primary care chronic pain toolkit of consultation models, prescribing guidance, deprescribing tools and patient leaflets. Self-management is a real part of pain care, and the February review said injections should open a door to that wider support rather than replace it. The toolkit is what the system can ship while 14 boards are left to “consider” theatre time.

The next Public Health Scotland pain-waiting release is due on 8 December 2026. It will not show whether Highland has finished its review, or whether any board has rewritten its pathway against the six procedures on the February list. Laing’s four-month cycle, and the 227 people who had already waited a year by 30 June, will sit in that gap until a board, or a minister, writes a rule that matches the evidence the government already paid for.

Disclaimer: This article is news reporting and analysis of NHS pain services, waiting times and published clinical advice. It is for information only and is not medical advice, a diagnosis, or a recommendation to start, stop or change any injection, infusion, medicine or pain programme. Readers who live with chronic pain, or who care for someone who does, should speak to their GP, pain specialist or another qualified clinician before making treatment decisions. Figures, service rules and waiting times are those given by the named bodies on the dates cited and can change as boards review pathways and as later statistics are issued.