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Persistent pain

PAEDIATRIC

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


Adult persistent pain

  •  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

Paediatric persistent pain

  • 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


  • Please consider phoning your local 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).
  • Note that CPC had been developed for Peripheral neuropathy within the Neurology CPC

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.
    • Specialist and GP referrals will be accepted if referring to Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS) at Queensland Children’s Hospital.  The patient should therefore have a specialist or GP prepared to work closely with QIPPPS.
  • The patient should not:
    • 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)
    • 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.

Clinical resources

Patient resources

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
    • 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.
    • Neuropathic pain (uncontrolled)
  • Category 2
    (appointment within 90 calendar days)
    • All other pain referrals that do not meet criteria for Category 1 or 3
    • Escalation of symptoms associated with escalation of functional disability (school attendance, engagement in physical activity, sleep, ADLs, mood changes, frequent emergency department attendance)
  • Category 3
    (appointment within 365 calendar days)
    • Patients that have previously seen a pain specialist and have stable symptoms and associated functional disability

     

    Please note that in the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • 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)
  • Assessments by other PPMS providers and/or other relevant specialist services (if available)
  • Current treatment from or referral to other specialist services for the same pain problem
  • Medications including past analgesia/medication trialled for pain condition
  • History of opiates/drugs of dependence for more than eight weeks
  • Functional status including details about school attendance and participation, sleep and sleep hygiene and physical activity (incidental and organised)
  • Details about participation in age appropriate ADLs
  • Psychological stressors / psychiatric history / cognitive function / engagement with mental health services
  • Living circumstances including details about complex family demographics and any custody arrangements where relevant
  • Investigations including pathology and imaging depending on the reason for referral (if available)

3. Additional referral information Useful for processing the referral

  • Family genogram

4. Request

Patient's Demographic Details

  • 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

Referring Practitioner Details

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

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
  • 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

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

Clinical modifiers

  • 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

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.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.