Chronic Pain Service (GP information)

Who can Refer

The Chronic Pain Service at Bedfordshire Hospitals NHS Foundation Trust provides care for patients in the locality of the hospital and the geographical area covered by BLMK ICS We accept referrals from MSK services in our locality via triage meetings as per the BLMK CCG guidance and also from recognised senior allied healthcare professionals and secondary care hospital consultants. Direct GP referrals are only accepted via triage and MDT discussion for non MSK related pain. ‘Out of area’ referrals are also to be discussed at the Pain MDT meetings.

Referral Criteria

Who to refer

• Those over the age of 18 only
• >3 months of persisting or recurring pain not adequately managed in primary care
• All relevant investigations and curative treatments are complete or excluded
• Community physiotherapy completed as appropriate.
• For MSK pain they have been seen and treated by a community MSK service and deemed suitable for referral to chronic pain clinic through existing external triage meetings
• Treatment as per relevant NICE Guidance has been followed for the condition and pain has not improved.
• When pain is causing significant functional impairment and/or distress, and has a negative impact on quality of life.
• Presence of psychosocial factors contributing to and/or exacerbating presentation of pain symptoms, and/or acting as a barrier to rehabilitation.
• Patients requiring specific procedures as part of a pain management plan aimed at improving function and quality of life.
• ‘Cancer survivors’ i.e. patients with cancer who have undergone treatment (e.g. surgery, chemotherapy or radiotherapy, but who have persistent pain.
• Those who are deemed unfit or are refusing a definitive surgical procedure that require pain management.
• Complex individuals with chronic and high dose opioid use (>120 mg Oral Morphine equivalent per day), however, the acceptance of the referral will be after an internal and if necessary, an external MDT involving the GP.

When not to refer

• Patients aged under 18 will NOT be accepted. Referral to nationally recognised, specialised services is required. Please follow the relevant guidance from the tertiary Centre.
• Patients who self-manage and cope with pain adequately.
• Those under the care of or in a treatment plan with another chronic pain service.
• Do NOT refer Patients under external community musculoskeletal services who have on-going treatment plans.
• Do NOT refer while investigations for, or treatments of the pain cause in other specialties are on-going.
• Do NOT refer Patients without a comprehensive clinical history and without examination findings or relevant investigations including scans and reports, as appropriate.
• If pain is NOT a predominant ‘presenting problem’, such as
  • Hypermobility syndromes
  • Hyperhidrosis
  • Chronic Fatigue syndrome
  • Non-painful neuropathies
  • Muscular spasms
• Do NOT refer patients whose priority is to identify a structural diagnosis or who expect curative treatment. We are unable to offer clinical diagnosis but can help manage the pain related to that diagnosis.
• Do NOT refer the same problem to multiple services in parallel (e.g. Orthopaedics as well as CPS).
• Do NOT refer while the pain problem is treated or investigated in other specialist services.
• Do NOT refer patients already under CPS to investigate ‘new’ pain; refer to the appropriate specialty instead for further investigation and diagnosis.
• For opioid or other substance withdrawal, please refer to Path2Recovery or ResoLUTiONs (Local addiction service).
• If funding for treatment recommend by the CPS has been declined by the BLMK ICS.
• Do NOT refer if there are any statements from CPS clinicians that no further treatment can be offered.
• If the patient has already attended a pain management programme (PMP).
• Patients should generally not be re-referred for the same pain problem; please contact us to discuss this prior to referring.
• Patients unable to get to the venues/ attend multiple appointments.
• Ongoing acute medical and/or acute mental health treatment in progress.

Referral letter requirements

Before patients are referred they should be made aware of the purpose and remit of the CPS.

Do NOT refer for and do NOT infer to patients what specific treatment to expect, such as injections, acupuncture, PMP or psychological treatments.

We do not currently accept email referrals. Referral letters that do not contain the information below cannot be accepted.

Referral letters

1. must e be from:
   • a consultant
   • GP
   • Senior AHP
   • or have been approved by the above and this should be clearly stated in the referral letter
2.  The letter must contain a comprehensive pain history and reason for referral including:
   • Focussed clinical history including but not limited to presenting symptoms and relevant examination findings and previous treatments including previous PMP.
   • Documentation of clinical red flags and need for urgency if any.
   • Review of investigations and their outcome. Please also check we are able to view these- if outside of area, or scans undertaken outside of Bedfordshire NHS Trust please ensure reports are enclosed and advise us in the referral where they were undertaken and we need to gain access.
   • Current and past pharmacological treatments.
   • Relevant past medical history.
   • Social and occupational impact of pain.
   • Patient expectations / objectives for intervention.
   • For specific complex patient PMP referrals, the referral team to discuss and document within the clinical consultation the reasons for referral to PMP and to discuss what outcomes are achievable at a PMP.

Consultant to Consultant secondary care internal referrals

• Please refer to the referral criteria above.
• Please note pain that if it is MSK in origin and has not been assessed by a community based MSK service, please advise the GP to refer to those services in the first instance.
• If referring directly from Bedford Hospital please ensure scans and test results are included within the referral and any recent clinical correspondence until such time as a shared record is available.
• If you require advice and guidance rather than a direct referral please contact us, and we can arrange a mutually convenient date for the referrer or deputy to attend our Pain MDT for discussion and support.
• Direct spinal team referrals for interventional injections please discuss at the spinal MDT.
• Failed back surgery referrals please arrange to discuss at the pain MDT.
• For non-complex Pain Management Programme please refer back to the GP to refer to the community based PMP provided by the MSK providers in the patient’s local locality.

Re-referrals

• If re-referring to the CPS please state whether a re-referral to the CPS is for a pain problem already managed before, or an additional new pain problem.
• Please check whether the patient has been discharged from the CPS; if NOT then a review should be requested via letter.
• Do NOT re-refer patients already under CPS to investigate new pain; refer to the appropriate specialty instead.
• Do NOT re-refer if there is a statement from CPS clinicians that no further treatment can be offered.
• Patients who have completed a Pain Management Programme (PMP) in the CPS should generally not be re-referred. Please discuss/ seek advice from the CPS before re-referring.