History and Examination

• Duration of chronic pain symptoms
• History of treatments trialled including pharmacological and non-pharmacological with outcomes and dosage
• Current medication
• Past medical history
• Psychosocial history including history of anxiety and depression and any treatments previously undergone for this
• Evaluation of suicide risk assessment where appropriate
• Visual Analogue Scale

Urgent Referrals – these referrals are not suitable under this pathway- please refer to the Pain Management General Clinic Clinical Referral Guideline 

Patients with the following should be referred urgently and don’t need to meet the referral criteria:

• Cancer pain
• Trigeminal Neuralgia
• Complex regional Pain Syndrome (CRPS) consistent with Budapest Criteria

Royal College of Physicians - Complex regional pain syndrome in adults - see Appendix 4

Please note we only accept urgent referrals for the three above conditions - please refer to the Pain Management General Clinic Clinical Referral Guideline

Try reasonable analgesia and if neuropathic pain, anti-neuropathic analgesia as per local guidelines.

South and West Devon Formulary

• Chronic Non-Malignant Pain
• Neuropathic Pain

North and East Devon Formulary

• Chronic Non-Malignant Pain
• Neuropathic Pain

Appropriate supportive therapy i.e., occupational therapy, physiotherapy and psychological support as available for current presentation.

Prior to referral, please consider the following:

• Please give consideration to whether simple measures have initially been trialled e.g., trial of analgesics, physiotherapy.

• Patient has been seen by Pain Management in last 18 months
  • Please consider whether re-referral is likely to change outcome

• Patient has completed Pain Management Programme, Body reprogramming course, or ACT programme.
  • Re-referral to discuss top up of skills learnt might be beneficial. In this case, please provide details and what you hope to achieve by referral.

We do not accept urgent referrals on this pathway.

Patients with the following should be referred urgently and don’t need to meet the referral criteria:

• Cancer pain
• Trigeminal Neuralgia
• Complex regional Pain Syndrome (CRPS) consistent with Budapest Criteria

Royal College of Physicians - Complex regional pain syndrome in adults please see Appendix 4 for Budapest Criteria (p55)

Please note we only accept urgent referrals for the three above conditions

Referral Criteria

• Patients aged 18 years of age or over
  AND
• Pain present longer than 6 months (despite primary care management)
  AND
• VAS 6/10 or greater (i.e. scale where 0/10= no pain, 10/10=worst pain imaginable)
  AND
• No underlying reversible pathology (unless discussed with and agreed by pain consultant or ACP staff)
  AND
• Not awaiting further investigations or opinion from other specialties regarding underlying cause of or treatment for pain

       AND

• Clear diagnosis agreed between referring clinician and patient (chronic primary pain is acceptable only if other diagnoses excluded).

       AND

• Patient understands they have chronic pain, and no further investigations will be performed

       AND

• Patient wants to be seen by PMSS for support and understands non-doctor pathway

       AND

• Red Flags excluded

       AND

• Blood screen (FBC, U&E, LFTs, bone profile, HbA1c, CRP, CK, Rheumatoid Factor, TFTs, and other screening tests to be undertaken as clinically indicated prior to referral, within the last year).

Please note:  Referrals not containing sufficient information with reference to the above referral criteria may be returned to the referrer. We DO NOT ACCEPT URGENT REFERALS ON THIS PATHWAY.

You are making a referral to a pain therapies service. In this service, patients will be supported to better manage their pain by the multidisciplinary team of pain specialist psychologists, physiotherapists, and nurses.

Patients will not be seen by a doctor. No medical management or interventionist approaches will be offered.

Please provide the following information in the referral:

• History of the pain problem and diagnosis.
• Blood results within 12 months (see above)
• Treatment summary (including pharmacological and non-pharmacological).
• Current medication.
• Past medical history.
• Psycho-social and Mental health history (including history of anxiety / depression, and any previous management, including discharge / report letters.
• Explicit evaluation of suicide risk assessment where appropriate.
• Clear documentation of the patients’ hopes and expectations.

For patients being re-referred:

• please include the following sentence:
  I am happy the diagnosis / clinical presentation hasn’t changed since previous referral, and the patient is appropriate to be seen in a non-medical pathway (please attach previous referral).
• Document Patient reasons for re-referral.

Referrals not containing sufficient information with reference to the above referral criteria may be returned.

GP Information

British Pain Society - Outcome measures 2019 - please see p9 for Visual Analogue Scale

Royal College of Physicians - Complex regional pain syndrome in adults - see Appendix 4 for Budapest Criteria (p55)

Patient Information

MyHealth Devon – Pain Management

Pathway Group

This guideline has been signed off by the UHP Pain Management team on behalf of NHS Devon.

Publication date: March 2024