Skip links and keyboard navigation

All Persistent Pain conditions

Useful management information

  • Please consider phoning your local Pain Rehabilitation Centre 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 Pain Rehabilitation Centre 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 Pain Rehabilitation Centre by their General Practitioner (GP). Referrals from internal medical or surgical specialists 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 Pain Rehabilitation Centre 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. 
  • Patient 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 workcover claim or actively involved in litigation, who should be considered for alternate pathways
    • That have been seen by another Pain Rehabilitation Centre within the last 12 months 
    • Where there is a clear statement by a Pain Rehabilitation Centre that there are no further or new therapeutic options

Clinical resources

 

Patient resources

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria? 

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Cancer pain where the patient’s specialist treating team is requesting Pain Rehabilitation Centre input
  • Patients on palliative care pathway where the patient’s specialist treating team is requesting Pain Rehabilitation Centre 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 even and can often not be made for 4 weeks. 

Category 2

(appointment within 90 calendar days)

  • Sub-acute pain (defined as lasting 6-12 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 a 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 your patient does not meet the minimum referral criteria 
  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
    • 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 (To be included in all referrals)

    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, BMI), 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
    • A comprehensive capture of information in relation to MSH Referral Criteria

    Clinical modifiers

    • The presence of clinical modifiers may impact the categorisation of the patient.
    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living functioning – low/medium/high
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    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 for All Persistent Pain conditions referrals (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) 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 (ATODS)
    • 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
      • Use of 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:
        1. all benzodiazepines
        2. codeine
        3. gabapentin
        4. pregabalin
        5. quetiapine
        6. tramadol
        7. zolpidem
        8. zopiclone.
    • 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 profile (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

    If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.​

    Additional referral information for All Persistent Pain conditions referrals

    • 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)
       

    Emergency

    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.

    • 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

    Out of catchment

    Metro South 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 South 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.

    Last updated 17 May 2024