Pain Clinic

 

The Service

The outpatient pain service provides a range of procedures. Their main purpose is to mitigate severe pain and support people in gaining ‘’ a window of opportunity ‘’ to help them with physical reactivation. Most pain procedures are short lived in their effects.

 

Primary care management prior to referral

• Adequately assess, exclude and/or manage treatable pathology and seek appropriate specialist opinion as deemed necessary. This includes a red flag assessment (see below).
• Explain remit & limitations of pain services to set patient’s expectations.

 

Referral criteria

Inclusion criteria

Patients must meet ALL 5 criteria for your referral to be accepted:

1. Need help to manage their pain despite optimal/adequate primary care input
2. Pain persisting for > 3 months
3. >/= 18 years old
4. NOT in the exclusion groups
5. NOT previously discharged from the pain clinic for the same problem

 

Exclusion criteria

Please do not refer the following patients to this service:

1) Presence of chronic pain in context of red flags

• Severe mental illness
• Unmanaged suicide risk
• Substantial unexplained weight loss
• Symptoms or signs of inflammatory joint disease or connective tissue disease
• Symptoms or signs of cardio-respiratory disease
• Clinically significant lymphadenopathy
• Widespread or progressive neurological symptoms
• Acute trauma
• Signs of cauda equina syndrome
• Unremitting night pain

2) Low back pain

• Refer to guidelines on ‘AQP Back Pain’ or ‘Adult Low Back Pain Guidelines’ under Spinal Neurosurgery:
• https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/spinal_neurosurgery

3) Fibromyalgia

• Refer to guidelines on ‘Fibromyalgia Syndrome’ under Rheumatology:
• https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rheumatology/fibromyalgia_syndrome_fms
• These patients can be seen for pain control not related to fibromyalgia

4) CFS/ME

• Refer to guidelines on ‘Chronic Fatigue Syndrome/Myalgic Encephalomyelitis’:
• https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/chronic_fatigue_syndrome_myalgic_encephalomyelitis
• These patients can be seen for pain control not related to CFS/ME

5) Headaches

• Must have been assessed first by neurology
• Refer to guidelines on ‘Headache’ under Neurology:
• https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/neurology/headache

6) Solely for acupuncture

• The pain clinic will provide 8 acupuncture sessions as part of an overall pain management strategy, but will not accept referrals solely for acupuncture

7) Vulvodynia

• Primary management by Dermatology team

8) Complex psychological problems not due to pain

 

Information required with referral

• Duration of pain
• Whether they have previously been seen in the pain clinic
• Whether red flags have been excluded
• Whether treatable pathology has been excluded or managed optimally
• Details of self-management and pharmacological management tried in primary care
• Associated psychosocial problems