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Pain Clinic

Definition of Chronic Pain

Chronic pain is pain persisting after the healing process has occurred or in the absence of tissue injury. It is sometimes defined as pain lasting or more than 3 months. It affects up to 45% of the population and can be very disabling. There has been a shift in management of patients with chronic pain to a model where the patient leads their own self-management program, the clinicians being facilitators only. Clinicians may find the information on this page useful. Click here for more information

 

CONSIDER REFERRING THE FOLLOWING PATIENTS TO PAIN CLINIC

Patients who

  1. Still need help to manage their pain
  2. AND who are not in the exclusion groups.

Consider inclusion of the following in your referral letter:

WHEN NOT TO REFER TO PAIN CLINIC

Please do not refer the following patients to pain clinic:

  1. Patients with Red Flag symptoms
  2. Patients with chronic pain who have not been adequately managed in primary care
  3. Please do not refer patients with back pain directly to the pain clinic. Please manage them using the AQP spinal and MSK Spinal clinics as per
    http://rms.kernowccg.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/pain_management/adult_low_back_pain_guidelines"

NOTE: Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica. MRI should be the modality of choice.  The only real indication for XR in GP is to assess osteoporotic collapse. Lateral spinal XR has a relatively high radiation dose AND SHOULD BE AVOIDED especially in young people and is unlikely to be of any use.

 

  1. Patients with an exclusive diagnosis of Widespread Chronic Pain or where there is a clear statement from the Pain Team that there are no further therapeutic options. The Pain Team are happy to offer email advice for such patients.
  2. Patients being referred for symptoms of fibromyalgia or ME/CFS. Note: patients with fibromyalgia, ME/CFS can be seen for pain control not related to fibromyalgia, ME/CFS
  3. Patients being referred solely for acupuncture. The Pain Clinic may provide a maximum of ten acupuncture sessions as part of an overall management strategy, but will not accept referrals solely for acupuncture.
  4. All other patients with pain problems where treatable pathology has been inadequately assessed, excluded or managed within primary care or by the appropriate specialty.

LINKS

RED and YELLOW FLAGS

https://www.eclipsesolutions.org/Cornwall/info.aspx?bnfotherid=7

Drug Treatment of Neuropathic Pain

Opiate Equivalence Tool part 1part 2

HAD score

Brief Pain Inventory: new patient and follow up

painDETECT questionnaire

STarT (assessment tool)

Optional Referral Proforma

Management of low back pain and sciatica useful link:

https://www.nice.org.uk/guidance/ng59/chapter/Recommendations