Chronic pain GP referral criteria - Hampshire Hospitals NHS ...

Appendix 1
Criteria for referring patients from General Practice
to the Chronic Pain Management Service
Contact Details:
The Chronic Pain Management Service, Basingstoke and North Hampshire Hospital
Aldermaston Road,
Basingstoke,
Hampshire,
RG24 9NA
Telephone: (01256) 314762 / 473202 ext. 4459
FAX: (01256) 354224
Referral Criteria:
Prior to referral: please ensure that the following conditions have been
appropriately managed:
• All patients displaying ‘red flag’ signs or symptoms (see below) should be referred to
the appropriate speciality for investigation/treatment as a matter of urgency
• Patients with radicular arm or leg pain should initially be referred to the spinal
surgeons
• Patients with mechanical spinal pain should have undergone a course of
physiotherapy, and have received an adequate trial of analgesia
• Patients with neuropathic pain, pins and needles and formication should have
received an adequate course of analgesia and commenced a trial of anti-neuropathic
pain medication as per Basingstoke, Southampton and Winchester District Prescribing
Committee: Persistent Pain Guidelines
• Patients with pelvic pain should have undergone investigation by members of the
appropriate gynaecological/urological specialities.
Basingstoke, Southampton and Winchester District Prescribing Committee: Guidelines
for the Pharmacological Management of Persistent Pain should be implemented and
monitored for a 6-week period prior to referral (see attached or go to
www.northhampshire.nhs.uk/gps-doctors/referral-guidance/-useful-information/chronicpain/
Exclusion Criteria:
• Pain problems where treatable pathology has been inadequately assessed and
excluded
• Severe unstable psychiatric illness
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Red flags
Factors that should trigger referral to appropriate specialist care, not to Chronic Pain Clinic:
Spine fracture
• Major trauma such as a vehicle accident or fall from height
• Minor trauma, or even just strenuous lifting, in people who may have osteoporosis
Cancer or infection
• Age over 50 years and new low back pain, or age under 20 years
• History of cancer
• Constitutional symptoms, e.g. fever, chills, unexplained weight loss
• Recent bacterial infection (e.g. urinary tract infection)
• Intravenous drug abuse
• Immune suppression
• Pain that worsens when supine; severe night-time pain
Cauda equina or rapidly progressing neurological deficit
• Saddle anaesthesia
• Recent onset bladder dysfunction (e.g. urine retention, increased frequency, overflow
incontinence)
• Severe or progressive neurological deficit in the lower extremities
• Unexpected laxity of the anal sphincter
• Perianal/perineal sensory loss
• Major motor weakness: knee extension, ankle plantar eversion, foot dorsiflexion
Urgent referrals/Acute
Most chronic pain does not require urgent assessment/treatment.
However, patients with the following may be referred urgently by Fax (01256 354224) and their assessment
will be expedited:
• Complex Regional Pain Syndrome
• New onset neuropathic pain
• Requiring a block for cancer pain
Routine referrals
For patients with chronic pain, i.e. pain, which has been persistent for a minimum period of 12 weeks,
we will accept referrals by letter, together with completed patient assessment forms
(see below), provided or if:
• the above guidance has been followed
• where possible, a diagnosis has been made
• the patient has not been referred to another specialty for the same problem
• patient is making excessive demands for treatment of their pain, or requesting a ‘second opinion’
• where there is significant or increasing disability or distress due to chronic pain
• the patient has poor self-management leading to excessive demands on primary health care
services
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