Specialty description

Tayside Pain Service is an adult highly specialist pain management service. Our specialist pain management department offers multidisciplinary approaches to managing complex pain when treatments options have been explored and exhausted in primary care. The main base of the Department is at Ninewells Hospital, Dundee. Peripheral clinics are held at Perth, and Stracathro.

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. This includes complex pain where pain is resulting in significant disability or distress.

We are clear with patients referred to the service that chronic pain is often difficult to improve directly with medications or direct interventions. Our aim is to support patients achieve the best quality of life, improve functional performance and enhance self-management strategies.

To meet this aim and to help patients achieve their goals, it is important that patients are prepared to engage in a proactive approach to living alongside chronic pain.

The support we provide may have a different format for specific needs. This includes:

  • Multi-disciplinary assessment and management by physiotherapy, psychology, pharmacy, nursing and medical staff.
  • Education, information and support for patients and their families and carers.
  • Medication management.
  • Pain management programmes.
  • Specialist clinics including chronic pelvic pain, pain and substance misuse, spinal cord stimulator clinic, Intrathecal drug delivery pump refill clinic.
  • Specialised interventions.

Who to refer

  • Patient residing in Tayside Health Board catchment area and 18 years of age or over.
  • Pain has been present for more than 3 months or longer than expected and an adverse impact on quality of life.
  • As the pain service is not an investigative service, please ensure all appropriate investigations and treatment have been explored and completed prior to referral. Patients should be aware that the ethos of the service is based on supported self-management. They are willing to explore & be able to make changes to their current activities & coping strategies.
  • When considering a referral for pain psychology within the pain team please consider this guidance - Pain psychology
  • When considering a referral for pain physiotherapy by AHP’s please consider this guidance – Specialist pain physiotherapy
  • Fibromyalgia If treatment and supported self-management have been exhausted referrals will be considered for highly specialist chronic pain assessment for Pain Management Programme.
  • Royal College of Physicians. Fibromyalgia syndrome - the essentials (patient information)

Fibromyalgia assessment and diagnosis should be completed in Primary Care along with pharmacological and non-pharmacological treatment options/supported self-management as outlined in guidance above and guidance from our Rheumatology colleagues as found in Rheumatology.

Re-referral

  • Patients should only be re-referred for the same problem if it is clear any previously identified barriers to engagement with what we are able to offer have been addressed and overcome. This should be highlighted in the re-referral.

If in any doubt, we request GPs to submit an advice request through SCI-Gateway or contact pain secretary to organise a multidisciplinary team consultation. The pain multi-disciplinary meeting takes every Wednesday afternoon. If you wish to discuss a complex case at the MDT meeting, please submit an advice request in SCI-Gateway.

Urgent referrals via SCI-Gateway

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 (CRPS) – The first line of treatment for patients with CRPS is urgent physical therapy and pharmacological. However, patients with severe symptoms (constant severe pain, unable to move) or those who do not respond to therapy should be referred on urgent basis. Treatment should be commenced urgently and certainly within six months of diagnosis.

The following documents provide more specific guidance on diagnosis, management and referral criteria:

Routine referrals via SCI-Gateway

Please ensure all prescribing guidance has been considered prior to referral. Please provide an overview of all analgesic and adjuvant therapies trialled in referral.

Tayside Chronic Pain Management guidelines prior to referral

Who not to refer

  • Patients who have not explored all options for chronic pain supported self management in primary care and appropriate community services. This includes: Pain Association Scotland monthly meetings, NHS Inform Chronic pain website resources, Flippin pain website resources, Live well with Pain (see links below under patient resources)
  • Current mental health issues severe enough to preclude engagement with a supported self-management approach, they are best managed by Mental Health Services (Major depression, psychosis and high risk of suicide or self-harm). Please see Pain psychology guidance
  • Patients with red flags: chronic pain patients with suspected spinal red flags 1 please investigate and/or refer to relevant specialty with appropriate degree of urgency (spinal fracture, cord compression, cauda equina, infection or malignancy).
  • Please do not refer patients who need admission as we are outpatient service only.
  • Patients who are currently attending a different speciality relating to their chronic pain e.g. patient with osteoarthritis attending orthopaedics and awaiting surgery.

Conditions that may benefit from a referral to an alternative service including links to primary care guidance where available

  • Cancer pain and cancer-treatment related pain (consider Palliative Care Team first)
  • Trigeminal neuralgia (Consider Neurology guidance first )

How to refer

Routine, urgent and advice referral via SCI-Gateway. There are no on call pain consultants.

Please do not use “Urgent” SCI-Gateway advice requests for referrals to be expedited.

To meet patient expectations to what the service can and cannot offer, please discuss with patient the ethos of the pain service described above. Patient and referrer expectations should be included in the referral form /letter.

Please do not page the in-patient pain team as they will not be able to provide assessment.

A copy of the questionnaire is available to print below. Please consider completing with patient OR ensuring patient is aware of the importance of this.

A pre-screening vetting questionnaire will be sent prior to referral being vetted. On return of questionnaire, the referral will be either accepted, re-directed or advice provided to referrer. Completion of this questionnaire aids triaging and may result in the patient not requiring an out-patient appointment. In the event that a patient cannot complete the questionnaire due to illiteracy, ASN please indicate this on the referral and the referral will be accepted without a returned questionnaire. Alternatively, the patient can contact us directly and explain they are unable to complete the questionnaire, and the referral will continue to be processed.

Pre-screening Questionnaire (NHS Tayside Intranet Only)

Pre-screening Questionnaire Cover Letter (NHS Tayside Intranet Only)

Useful resources and information

Staff Resources

NHS Scotland. Quality prescribing for chronic pain: a guide for improvement 2018-2021.
NHS Education for Scotland. Understanding chronic pain.
SIGN 136. Management of chronic pain: a national clinical guideline. 
Faculty of Pain Medicine of the Royal College of Anaesthetists:

Patient Resources

NHS Inform. Chronic pain
NHS Inform. Managing your mental health when you have chronic pain 
NHS Inform. Fibromyalgia
Pain Association Scotland. Pain management course
Live Well With Pain
Flippin Pain
Pain Concern

References

1. NICE CKS. Sciatica (lumbar radiculopathy): red flags symptoms and signs. Last revised in January 2025. Available from: https://cks.nice.org.uk/topics/sciatica-lumbar-radiculopathy/diagnosis/red-flag-symptoms-signs/

Editorial Information

Last reviewed: 14/01/2026

Next review date: 14/01/2028

Version: 01.0