Persistent Pain
Adult

Interdisciplinary Persistent Pain Centre

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Emergency Referrals

Useful Management Information

Please consider phoning your local Persistent Pain Management Service (PPMS) for advice regarding medication optimisation or opioid deprescribing. Please consider the regulatory requirements for opioid prescribing and seek advice from the S8 enquiry service at Medicines Regulation and Quality  (MRQ).
Before referring to a persistent pain service please consider the following:

The patient should:

have persistent pain resulting in functional impairment from physical disability and/or psychosocial issues
have persistent pain that has been fully investigated
be referred to the PPMS by their General Practitioner (GP). Referrals from internal medical or surgical specialist are accepted if the condition is considered a category 1 priority only. All other conditions need to be referred by the patient’s GP have a GP prepared to work closely with the PPMS and to provide ongoing community management.

The patient should not:

have unstable, non-therapeutic drug dependence without concurrent treatment by a drug and alcohol specialist
have an active, untreated mental health condition be undergoing treatment from other specialist services for the same pain problem without mutual awareness and agreement of cross referral by both teams.

Patients who may not benefit include those:

with cognitive impairment that prevents understanding of treatment and management goals (unless adequate support from carer +/- social support network)
accepted under a WorkCover claim or actively involved in litigation, who should be considered for alternate pathways
that have been seen by another PPMS within the last 12 months
where there is a clear statement by a PPMS that there are no further or new therapeutic options

Clinician resources

The Australian Pain Society

Faculty of Pain Medicine

International Association for the Study of Pain (IASP) Statement on Opioids

British Pain Society CRPS guidelines

RACGP

ANZCA – Acute pain management: Scientific evidence

Downloadable opioid calculator

Australian Association of Musculoskeletal Medicine

Hunter Integrated Pain Service

Pain toolkit

Queensland Health: Chronic conditions manual

Therapeutic Guidelines (eTG)

Patient resources

Chronic Pain Australia

Pain Australia

Australian Pain Management Association

Amputees and Family Support Group Queensland Inc.

Arthritis Queensland

Endometriosis Association (Queensland) Inc.

Lupus Australia, Queensland Inc.

ME/CFS/FM Support Association Queensland Inc.

MS Queensland

Palliative Care Queensland

Queensland Self-Management Alliance

Consumers Health Forum of Australia Inc.

Pelvic Pain Foundation

ACI Pain Management Network (NSW)

ACI Pain Management Network: Our Mob  (indigenous specific resources)

Smiling mind  – mindfulness app

Minimum Referral Criteria

Does your patient meet the 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 New onset neuropathic pain of less than 6 weeks duration relating to a recent diagnosis of a condition for example: herpes zoster (risk for post herpetic neuralgia) ischaemic pain trigeminal neuralgia brachial plexopathy diabetic neuropathy multiple sclerosis spinal cord injury post stroke pain 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.
Category 2 (appointment within 90 calendar days)	Sub-acute pain (defined as lasting 6 to 12 weeks) with risk of functional deterioration Exacerbation of neuropathic pain from pre-existing conditions as listed in Category 1 Patients with frequent emergency department / primary care presentations for exacerbations of persistent pain despite attempts at management Complex pain presentation resulting in marked psychological distress (note that patient must also be under the care of a mental health clinician) Complex pain presentation resulting in marked functional impairment Pain with onset less than 6 months ago that is resulting in psychological and/or functional impairment, that is not responding to primary care management Functional impairment as a result of severe or complex side effects from pain medications that are not able to be managed in primary care
Category 3 (appointment within 365 calendar days)	Pain with onset more than 6 months ago that is resulting in psychological and/or functional impairment, that is not responding to primary care management
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Pain history:
- date of injury/onset of pain
- likely proposed mechanism of injury
- location and nature of pain
- history of treatment for pain
Physical examination findings
Provisional diagnosis (if determined) from either GP or another treating specialist for the condition/s
Assessments by other persistent pain service providers and/or other specialist services including psychiatry/psychology/Alcohol Tobacco and Other Drugs Service (Alcohol and other drugs - AODS)
Current treatment from or referral to other specialist services for the same pain problem
Medications including past analgesia/medication trialled for pain condition
Any past medical history
Statement of history, even if negative, of the following:
- History of alcohol/substance abuse and/or medication misuse
- History of opiates/drugs of dependence for more than eight weeks
Medicines Regulation and Quality (MRQ) (formally DDU) approval details and MRQ prescription history (if available)
Functional status
Psychological stressors / psychiatric history / cognitive function

Investigations as listed below depending on the reason for referral. Please refer to Choosing Wisely Australia  to reduce unnecessary tests, treatments and procedures.

Back pain

Orthopaedic or neurosurgery report (if available)
Previous relevant diagnostic imaging: CT/MRI/Other (if available)

Headaches/Cranial Nerve Pain

Recent neurology report (if available)
Previous relevant diagnostic imaging: CT/MRI/Other (if available)

Joint pain

Rheumatology report (if available)

Neuropathic pain

Previous nerve conduction studies where relevant (if available)

Chronic visceral pain

Urology and gastroenterology reports (if available)

Chronic pelvic pain

Obstetric/gynaecological history
Past procedures and treatment outcomes

Malignancy pain

Past procedures and treatment outcomes
Oncology or palliative care reports

Additional Referral Information

Other relevant reports from any providers in a public or private sector related to the presenting problem
Family and social history

Musculoskeletal pain/osteoporosis/chronic high dose opioids:

Vitamin D, ionised calcium, magnesium
Bone mineral density
Testosterone level
If inflammatory arthropathies include ESR, CRP results

Neuropathic pain:

Results relevant to diagnosing aetiology of peripheral neuropathy
HbA1c (if diabetic)

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Persistent Pain (E-Blueslips)

Fax

(07) 5687 4497

Post

Suite 3 Campus Alpha,
2 Investigator Drive
Robina QLD 4226

Enquiries

(07) 5668 6825

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Persistent PainAdult