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Persistent pain


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Cancer pain where the patient's specialist treating team is requesting Persistent Pain Management Service (PPMS) input
    • Patients on a palliative care pathway where the patient's specialist treating team is requesting PPMS input
    • Worsening post-surgical pain of less than 3 months duration (where a post-operative complication has been excluded)
    • Newly diagnosed or suspected complex regional pain syndrome (CRPS). Note that this is a diagnosis of exclusion. Diagnosis becomes more reliable greater than 6 weeks after the triggering event and can often not be made before 4 weeks.
    • Neuropathic pain (uncontrolled)
  • Category 2
    (appointment within 90 calendar days)
    • All other pain referrals that do not meet criteria for Category 1 or 3
    • Congential pain (uncontrolled)
    • Escalation of symptoms associated with escalation of functional disability (school attendance, engagement in physical activity, sleep, ADLs, mood changes, frequent emergency department attendance)
  • Category 3
    (appointment within 365 calendar days)
    • Patients that have previously seen a pain specialist and have stable symptoms and associated functional disability

    Please note that in the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • Pain history:
    • date of injury/onset of pain
    • likely proposed cause of pain or mechanism of injury
    • location and nature of pain
    • history of treatment for pain
  • Physical examination findings
  • Developmental/neurodevelopmental vulnerabilities and mental health history
  • Provisional diagnosis (if determined)
  • Assessments by other PPMS providers and/or other relevant specialist services (if available)
  • Current treatment from or referral to other specialist services for the same pain problem
  • Medications including past analgesia/medication trialled for pain condition
  • History of opiates/drugs of dependence for more than eight weeks
  • Functional status including details about school attendance and participation, sleep and sleep hygiene and physical activity (incidental and organised)
  • Details about participation in age appropriate ADLs
  • Psychological stressors / psychiatric history / cognitive function / engagement with mental health services
  • Living circumstances including details about complex family demographics and any custody arrangements where relevant
  • Investigations including pathology and imaging depending on the reason for referral (if available)

3. Additional referral information Useful for processing the referral

  • Family genogram

4. Request

Last updated: 13 June 2023