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Persistent Pain – Adult

Red flags

The Persistent Pain Management Service for Metro North is based at the Surgical, Treatment and Rehabilitation Service (STARS). For urgent referrals phone on call Persistent Pain Registrar via Royal Brisbane & Womens' Hospital switch - (07) 3646 8111

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Patients with acute pain (and no provisional diagnosis)
  • Patients with acute pain and new neurological symptoms eg Cauda Equina Syndrome (CES)
  • Patients requiring acute mental health services
  • Concerns pertinent to any medical/surgical condition which raise the possibility of serious underlying disease (malignancy or infection) should be reviewed by the appropriate specialty either via emergency department or high priority outpatient appointment.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Cancer pain where the patient’s specialist treating team is requesting 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 pain following surgery, procedures, or trauma of less than 3 months duration (where a surgically treatable complication has been excluded and/or managed)
  • Newly diagnosed or suspected new onset (3 months) of complex regional pain syndrome (CRPS) based on the Budapest criteria

Category 2

Appointment within 90 days is desirable

  • Sub-acute pain (defined as lasting 6 to 12 weeks) with moderate to high 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
  • Adolescents and young adults who are at risk of non-attendance at school/study/work, or elderly and frail adults experiencing, or at risk of, declining quality of life
  • Complex pain presentation resulting in marked psychological distress (note that patient must also be under the care of a mental health clinician where there are escalating risk concerns)
  • 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
  • Individuals at risk of work cessation due to persistent pain

Category 3

Appointment within 365 days is desirable

  • 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 your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • 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

Other important information for referring practitioners

  • Note that CPC has been developed for Peripheral neuropathy within the Neurology CPC
  • The CPC include direct Queensland Health Pain Specialist to Queensland Health Pain Specialist referral when a patient moves from one catchment area to another, or when the patient has accessed any statewide service offering Pain Specialist input where further local Pain Management services are indicated
  • Referrals from internal medical or surgical specialist are accepted if the condition is considered a category 1 priority All other conditions need to be referred by the patient’s GP.

All other conditions need to be referred by the patient’s GP. 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
  • And have a referring GP who a discharge report can be provided to.

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:

  • Accepted under an insurance claim e.g., Workcover/having treatment in the private system
  • For whom litigation may be a barrier to rehabilitation
  • Where there is a clear statement by a PPMS that there are no further or new therapeutic options

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

  • Pain history:
    • date of injury/onset of pain
    • likely proposed mechanism of injury
    • location and nature of pain
  • Detailed history of treatment for pain (both pharmacological and nonpharmacological)
  • Physical examination findings
  • Provisional diagnosis (if determined) from either GP or another treating specialist for the condition/s
  • Relevant social information/history
  • Vulnerable groups e.g., Aboriginal and Torres Strait Islander people, refugees, Culturally and Linguistically Diverse (CALD)
  • Accompanying carer or need for interpreter services
  • Letters/reports/assessments by other health professionals involved in diagnosis or management of the pain issue, for example correspondence by other persistent pain service providers, physicians, surgeons, psychiatrists, psychologists, Alcohol Tobacco, and Other Drugs Service
  • Medications
  • 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
    • Use of marijuana in addition to medicinal marijuana / CBD oil
  • Any patient that is prescribed one of the following medications should be checked through Q script by the relevant Health Professional.
    • all schedule 8 medicines (e.g. opioids, alprazolam, nabiximols, dexamphetamine)
    • the following schedule 4 medicines:
      • all benzodiazepines
      • codeine
      • gabapentin
      • pregabalin
      • quetiapine
      • tramadol
      • zolpidem
      • zopiclone
    • Functional status
    • Psychological stressors / psychiatric history / cognitive function

All relevant investigations and reports 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, Useful for processing the referral

History and Examination

  • 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)

 

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • 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

  • 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
  • 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
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)

Send referral

Hotline: 1300 364 938

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail:
Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

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