Pain Management Service

Intro/background

NHS Ayrshire & Arran Pain Management Service provides outpatient multidisciplinary assessment and management plans for adults with persistent pain lasting greater than 3 months.

The team in A&A comprises Doctors in Pain Management, Specialist Physiotherapists, Clinical Psychologist, Specialist Nurses, Occupational Therapists and Pharmacists.

The overall vision of the service is to improve the quality of life of people living with persistent pain by supporting self-management and enabling people to live better with their pain by addressing what matters to them through efficient use of resources.

Medicines are optimised due to their limited benefit in persistent pain and can, at best, expect to reduce pain by around 30%-50%.

Who to refer

Inclusion criteria:

Over 18 years of age.
Significant pain for more than 3 months associated with substantial distress, disability or disruption of normal life.
All investigations / treatments have been completed (unless discussed with a Pain Clinician prior to referral) and who are accepting of this and not seeking further treatment.
Had medication trials appropriate to their condition (See NHS Ayrshire & Arran ADTC 118: Pharmacological and Other Management of Persistent Pain - only available on Athena intranet)
Seeking support with rationalisation of analgesic medicines.
Ready to adopt a pain self-management approach involving active engagement with the Pain Management Service.
Signposted to third sector/community services such as Pain Concern, Leisure / Activity for health, Pain Management Service website, Pain Association Scotland.

Who not to refer

Exclusion criteria:

Presence of red flags (refer to appropriate speciality)
Patients expecting a cure for their long term condition.
Awaiting investigations or specialist opinion, test results, or invasive treatment for pain-related condition.
Currently attending or referred to another service that may assist with pain management (e.g. Rheumatology, Orthopaedics)
Less complex musculoskeletal (MSK) pain with shorter duration of pain should initially be referred to the MSK Service.
Significant mental health problems and/or chaotic alcohol/drug dependency behaviour that is not appropriately managed should be referred to the appropriate service/agency.
Headache – consider Neurology referral in the first instance.
Current pregnancy or breast feeding.
Prescribing of high dose opioids and benzodiazepines are associated with reduced ability to cope with pain, significant low mood issues and impair ability to engage in self-management. Progression through the service will be limited until these medications are rationalised.
Seeking procedures or injections.
Re-referral with the same pain problem once all therapeutic options have been exhausted (unless they are now more accepting of a pain self-management approach)

Non-attendance at any aspect of our service will result in a patient being discharged from the service.

When & how to refer

Referral process:

Primary Care use SCI gateway to refer.
Secondary Care dictate a letter and copy to Referral Management Service.
AHP use the AHP referral form and forward to aa.clinicalpainmanagementphysio@aapct.scot.nhs.uk.

Referrals must include:

The pain problem (e.g. location, duration, causation, diagnosis)
Relevant referrals/investigations/treatments that have been undertaken.
Medications and previous analgesic trials including dose, effects, side-effects.
Previous involvement with MSK Physiotherapy or other rehabilitation services appropriate to condition.
Previous attendance at Pain Management Service, including consultant name and reason for re-referral.
Medical, psychological and social history.
The patient's expectations of referral (Include details of patient's acceptance that the service will focus on self-management aimed at improving quality of life)
Your expectations as referrer (e.g. medical management, multidisciplinary help /management, psychological help/support)

If this information is not supplied, we will not be able to assess the referral or make recommendations. The referral will be returned seeking clarification.

What happens next?

All referrals are considered at the weekly Pain Management Service vetting meeting by the multi-disciplinary team. Cases are discussed using the information provided within your referral along with the patient’s hospital notes. A decision will then be made based on the referral criteria with one of the following outcomes:

The patient is accepted into the service, and they will be added to our waiting list. Most patients will attend a group pain early information session prior to being seen on a 1:1 basis.
The referral is declined as it does not meet the referral criteria and the referrer will be informed of the reasoning for this decision by letter. Patients will be sent a standard decline letter.
There was insufficient information available to make a decision and the referrer will be contacted for the required information.
Some patients will be provided with an opt-in letter with an agreed timeframe to accept the invitation to be added to the waiting list. This will usually be utilised if individuals fall into one of the following categories;
- Previous input from the Pain Management Service.
- Specific requests within the referral for interventions that are not offered within the service e.g. medical cannabis or injections.
- If the MDT feel it would be most appropriate to fully inform the patient of the aims of the service due to unclear expectations within the referral.