Rejection of referrals for Pain Management
As most GPs will be aware, the statewide referral criteria (below) for acceptance to Pain Management have changed. This has resulted in significant referral rejections, which is frustrating for referrers, patients and access teams.
Pain management is an interdisciplinary approach to managing pain that prompts self-management in a biopsychosocial framework. The new criteria reflect this by requesting that referrals are also based in this framework, but also highlights risks:
- That patients may have other factors that need addressing
- A diagnosis of PTSD
- Previous failed involvement with a pain management approach
- Substance use disorder or medication dependence
The most important criteria is the patient’s understanding that this approach includes their active involvement; this should trigger a conversation about active self-management with your patient.
Detail for a successful referral
At a minimum, a referral should include:
- Biomedical:
The pain is this, investigations show this, opinion from a specialist is this, working diagnosis is this - Function:
They previously did this, and now they can do this and struggle with that - Psychological:
Their mood has changed and/or they had previous/ongoing psychological/psychiatry involvement - Social:
The social situation was this, and is now limited to this - Treatment to date (and the outcome):
Medication, physical, psychological approaches, other approaches - Risks:
Diagnosis or symptoms of PTSD, history of traumatic events, substance use disorders, possible medication dependence/misuse, ‘failed’ treatment - Willingness to engage:
They have some understanding of the self-management approach and are able and motivated to participate
Statewide referral criteria for Pain Management Clinic
Referral criteria – all need to be met:
- Persistent or chronic pain (>3 months duration) with symptoms that impact daily activities, including impact on work, study, school or caring role
- Adequate trial of treatment in previous 12 months (exercise and analgesia)
- At risk of functional or psychological deterioration, or medication dependence
- Willing to explore living well with pain and is willing to learn to self-manage ongoing pain
Provide the following information with the referral:
- Pain history: onset, location, nature of pain and duration
- Psychological status and cognitive function
- If the person has symptoms of, or has been diagnosed with, post-traumatic stress disorder (PTSD)
- Details of previous pain management including the course of treatment(s) and outcome of treatment(s)
- History of alcohol, recreational or injectable drugs, or prescription medicine misuse
For more information, visit the Pain Management Clinic page on our website or phone (03) 9265 1411.