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Pain Clinic

A17

Referral Guidelines

pain clinic image We are in general happy to see any patient who has pain, although there are a few things that should be considered before referral.

Many patients benefit from a trial of simple analgesics, such as paracetamol and non-steroidals. If that is the case, we would not normally need to review them.

If there is a suggestion that the patient has a neuropathic element to their pain (see Neuropathic Pain), a trial of a tricyclic would normally be appropriate. We recommend either amitriptyline or nortriptyline (see the Analgesic Ladder for Neuropathic Pain in "drug treatments"). While we try to ensure that an important diagnosis has not been missed, we are not primarily a diagnostic centre, except in the sense of diagnosing pain syndromes such as complex regional pain syndromes (CRPS). If a diagnosis has not yet been made, it may be more suitable for the patient to be seen by a relevant specialist first.

After considering the above, the following conditions are appropriate for initial referral:

Some conditions are not considered appropriate for initial referral, as further specialist investigation may be needed. It is for the responsible clinician to decide whether an initial referral to the Pain Clinic would be correct, after all.

The following conditions are normally considered inappropriate for initial referral:

Finally, if there is a clear statement by a Pain Consultant that there are no further reasonable therapeutic options, then other than for a rehabilitative approach, the patient should not be re-referred with the same pain problem.


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