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Chronic Pain Disposition Plan

Follow-up and co-ordination of patient care is key to improving long-term outcomes.

Referring back to GP, consider any/all of the following:

  • psychosocial intervention for yellow flags - addressing unhelpful beliefs and behaviours [1] (clinical psychology) and treatment for depression
  • pharmacotherapy for neuropathic pain (TCA, SNRI, gabapentin, pregabalin) [2]
  • physiotherapy referral for gradual conditioning and activity pacing
  • having the patient complete a plan for flare-up (APMA and ACI)
  • education regarding non-pharmacological self-management strategies (including referral to NSW ACI Chronic Pain website)
  • discussion/plan regarding opioid reduction*
  • pain specialist referral for debilitating symptoms, escalating needs, poor response to therapy, use of high doses of opioids (>100mg morphine equivalents/day) and major disability (physical or psychological) [3]

Patients repeatedly presenting may require development of an ED Management Plan in collaboration with relevant services

* For people already taking long term opioids for chronic non-cancer pain the standard approach is to wean and cease [4]. The time frame can vary from a few weeks up to a year. This is best managed by a GP or specialist with whom the patient has rapport, but the idea can be introduced in ED.

Further References and Resources

[1] Nicholas, M.K., et al., Early identification and management of psychological risk factors ("yellow flags") in patients with low back pain: a reappraisal. Physical Therapy, 2011. 91(5): p. 737-53.

[2] Cohen, M.L., Principles of prescribing for persistent non-cancer pain. Australian Prescriber, 2013. 36: p. 113-115.

[3] ACI Pain Management Network Website. Chronic Pain Services in NSW. 2014.

[4] ACI Pain Management Network Website. How to de-prescribe and wean opioids in general practice. 2016.

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