Chronic pain is pain that has lasted for longer than 3 months, after the usual recovery period for an illness or injury, or as a result of a chronic condition.
The purpose of the chronic pain team is to facilitate safe and effective pain management for people referred to our service.
Our aim is to help patients achieve the best quality of life, improve functional performance and enhance self-management strategies.
We provide a range of services including;
• Multi-disciplinary assessment and management by physiotherapy, psychology, pharmacy, nurse and medical staff
• Pain Management Programmes
• Education, information and support for patients and their families and carers
• Specialised Interventions
• Medication Management
We have clinics based at: Ninewells Hospital, Perth Royal Infirmary, and Stracathro Hospital, while providing remote access clinics.
Pain service
CONTENT UNDER REVIEW
Who We Are
Who to refer
Indications for referral:
· Adults aged 18 and over (persons under 18 may be considered through discussion with the service)
· Pain persisted for longer than 3 months
· Pain is not managed despite implementing Pain Service Clinical guidance (see links at bottom of page), including self-management and where there is a significant or increasing disability or distress due to chronic pain.
Psychology is provided within the Tayside Pain Service by clinical health psychologists. Treatment is provided using psychological models of adjustment to long term physical health conditions with the aim of promoting adjustment, adaptive coping and self-management of chronic pain. There must be a clear link between the patient’s psychological difficulties and their chronic pain problem.
If referring for psychological support (via Pain Management on SCI-Gateway) please review the psychology eligibility guidance prior to referral.
Addiction or dependence, and/or problematic analgesic use, or ongoing involvement with the Integrated Substance Misuse Service (ISMS). The patient may be appropriate for assessment in the Pain and Dependency Clinic. This is a joint clinic with input from both the Tayside Pain Service and ISMS. Please note in the referral if you want the patient to be considered for this clinic, AND ensure that the patient is happy to attend such a clinic.
Re-referral
Please do not re-refer patients who are still presenting with the same condition, if guidance in previous correspondence has not been implemented.
For advice please use SCI-Gateway ADVICE REQUEST or email Tay.taysidepainservice@nhs.scot.
Early referral
Most chronic pain does not require urgent assessment/treatment, however patients with the following may be referred urgently and their assessment will be expedited:
· Complex Regional Pain Syndrome
· New onset neuropathic pain
· Cancer pain and cancer-treatment related pain (consider Palliative Care Team first)
· Adults aged 18 and over (persons under 18 may be considered through discussion with the service)
· Pain persisted for longer than 3 months
· Pain is not managed despite implementing Pain Service Clinical guidance (see links at bottom of page), including self-management and where there is a significant or increasing disability or distress due to chronic pain.
Psychology is provided within the Tayside Pain Service by clinical health psychologists. Treatment is provided using psychological models of adjustment to long term physical health conditions with the aim of promoting adjustment, adaptive coping and self-management of chronic pain. There must be a clear link between the patient’s psychological difficulties and their chronic pain problem.
If referring for psychological support (via Pain Management on SCI-Gateway) please review the psychology eligibility guidance prior to referral.
Addiction or dependence, and/or problematic analgesic use, or ongoing involvement with the Integrated Substance Misuse Service (ISMS). The patient may be appropriate for assessment in the Pain and Dependency Clinic. This is a joint clinic with input from both the Tayside Pain Service and ISMS. Please note in the referral if you want the patient to be considered for this clinic, AND ensure that the patient is happy to attend such a clinic.
Re-referral
Please do not re-refer patients who are still presenting with the same condition, if guidance in previous correspondence has not been implemented.
For advice please use SCI-Gateway ADVICE REQUEST or email Tay.taysidepainservice@nhs.scot.
Early referral
Most chronic pain does not require urgent assessment/treatment, however patients with the following may be referred urgently and their assessment will be expedited:
· Complex Regional Pain Syndrome
· New onset neuropathic pain
· Cancer pain and cancer-treatment related pain (consider Palliative Care Team first)
Considerations prior to referral
- Patients with neuropathic pain or mixed pain should have received an adequate course of analgesia and commenced a trial of anti-neuropathic pain medication, as per guidelines linked at bottom of page.
- Any referral to the pain service to specifically request Lidocaine plasters - needs to meet the Lidocaine Tayside formulary recommendations or can not be accepted (see neuropathic pain pathway link at bottom of page).
- Patients with mechanical spinal pain and musculoskeletal pain should have undergone a recent adequate course of Physiotherapy prior to referral.
- The patient should not be undergoing treatment from other specialist services for the same pain problem without mutual awareness and agreement of cross-referral by both teams.
How to refer
Please use SCI-Gateway; pain management or letter to refer. If you would like advice only, use SCI-Gateway pain management advice request.
• Please ensure the patient referral is directed to the Pain Service in their geographical area; either Ninewells, Perth or Stracathro catchment areas.
• Please include specific reason for referral, if this is a re-referral, is this a new problem?
• If medication is being withdrawn, please provide specific rationale for this e.g. Opioid tolerance, opioid divergence, lack of efficacy, opioid >90mg daily dose.
• Discuss with the patient their understanding of the reasons for referral and inform them that a questionnaire will have to be completed by them prior to an appointment with the Pain Service. Please do not suggest specific treatments to patients prior to referral. Pharmacological and non-pharmacological approaches will be discussed with the patient, and a plan of care will be developed in partnership. Patients must be ready to embrace self-management.
• Please ensure the patient referral is directed to the Pain Service in their geographical area; either Ninewells, Perth or Stracathro catchment areas.
• Please include specific reason for referral, if this is a re-referral, is this a new problem?
• If medication is being withdrawn, please provide specific rationale for this e.g. Opioid tolerance, opioid divergence, lack of efficacy, opioid >90mg daily dose.
• Discuss with the patient their understanding of the reasons for referral and inform them that a questionnaire will have to be completed by them prior to an appointment with the Pain Service. Please do not suggest specific treatments to patients prior to referral. Pharmacological and non-pharmacological approaches will be discussed with the patient, and a plan of care will be developed in partnership. Patients must be ready to embrace self-management.
Useful resources
NHS Tayside Staffnet Pain website
NHS Inform Chronic pain self-help guide
Silver Cloud is a specifically tailored computerised CBT package for anxiety and/or depression arising from chronic pain, social anxiety and health anxiety. GP’s can refer directly to this service by completing this linked referral page and emailing back to the address listed at the bottom of the form.
Pain Association provides self-management training for people with chronic pain.
Looks at the non-medical issues, particularly the disabling effects of chronic pain on people’s lives. The aim is to introduce people to, and quickly build, self-management skills, creating practical, positive change leading to an improved quality of life and well-being.
Retrain Pain Foundation
The Pain Toolkit
NHS Inform Chronic pain self-help guide
Silver Cloud is a specifically tailored computerised CBT package for anxiety and/or depression arising from chronic pain, social anxiety and health anxiety. GP’s can refer directly to this service by completing this linked referral page and emailing back to the address listed at the bottom of the form.
Pain Association provides self-management training for people with chronic pain.
Looks at the non-medical issues, particularly the disabling effects of chronic pain on people’s lives. The aim is to introduce people to, and quickly build, self-management skills, creating practical, positive change leading to an improved quality of life and well-being.
Retrain Pain Foundation
The Pain Toolkit