Persistent pain
ADULT
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Adult persistent pain
- Patients with acute pain (and no provisional diagnosis)
- Patients with acute pain and new neurological symptoms e.g. 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 harm occurring to the body due to serious underlying disease (e.g. inflammatory condition, infection or malignancy) should be reviewed by the appropriate specialty either via emergency department or high priority outpatient appointment
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| Category 1 (appointment within 30 calendar days) |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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Please insert the below information and minimum referral criteria into referral
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
- Detailed history of treatment for pain (both pharmacological and nonpharmacological)
- Physical examination findings
- Provisional diagnosis (if determined) from either GP or another treating specialist for the condition/s
- Relevant social information/history
- Vulnerable groups e.g., Aboriginal and Torres Strait Islander people, refugees, Culturally and Linguistically Diverse (CALD)
- Accompanying carer or need for interpreter services
- Letters/reports/assessments by other health professionals involved in diagnosis or management of the pain issue, for example correspondence by other persistent pain service providers, physicians, surgeons, psychiatrists, psychologists, Alcohol Tobacco, and Other Drugs Service
- Medications
- 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 marijuana in addition to medical 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:
- all benzodiazepines
- codeine
- gabapentin
- pregabalin
- quetiapine
- tramadol
- zolpidem
- zopiclone.
- Functional status
- Psychological stressors / psychiatric history / cognitive function
All relevant 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 report (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
3. Additional referral information Useful for processing the referral
- 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)
4. Request
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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.)
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
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.
Last updated: 6 June 2024
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