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.
The following links have useful management guides for:
- the de-medicalisation of chronic pain
- de-prescribing opioids
- information for patients about opioids
- the opioid contract
- Assessing chronic pain
- prescribing for pain
CONSIDER REFERRING THE FOLLOWING PATIENTS TO PAIN CLINIC
- Still need help to manage their pain
- AND who are not in the exclusion groups.
- AND are 18y and older
Consider inclusion of the following in your referral letter:
- Completed Optional Referral Proforma
- Details of self-management and pharmacological management tried in primary care
WHEN NOT TO REFER TO PAIN CLINIC
Please do not refer the following patients to pain clinic:
- Patients with Red Flag symptoms
- Patients with chronic pain who have not been adequately managed in primary care
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
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.
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.
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
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.
All other patients with pain problems where treatable pathology has been inadequately assessed, excluded or managed within primary care or by the appropriate specialty.
Patient who have not been assessed by neurology for headache.
Patients with complex psychological problems due to pain not related to musculoskeletal cause
Management of low back pain and sciatica useful link:
Date reviewed 25/02/19
Next review due 25/02/20 (12 months after)
Sifter name: Jo Parry
Consultant name: Juan Graterol