Published April 2026. Next review: 2031
Persistent pain after traumatic injury is common and can lead to chronic pain and opioid dependence if not managed effectively. The Trauma Pain Pathway supports clinicians to provide care for patients with persistent pain.
NSW trauma patient-reported measures show pain remains a major issue post-discharge, impacting recovery and quality of life. Evidence indicates that moderate to severe pain persists in more than 50% of trauma patients up to 6 months after discharge. Inadequate pain control and education on self-management principles are a major contributor.
Improving discharge practices and providing patients with clear, consistent and accessible pain management information is critical. A structured pain pathway can help clinicians deliver evidence-informed care, promote safe opioid tapering, and encourage alternative self-management strategies. This ultimately reduces the risk of chronic pain and improves patient outcomes.
To address these gaps, we collaborated with the Pain Management Network and the John Walsh Centre for Rehabilitation Research to develop the Trauma Pain Pathway to help prevent chronic pain and reduce opioid use.
The pathway supports clinicians across 3 key touchpoints:
- Discharge (3–5 days pre-discharge)
- First follow up (4 weeks post-discharge)
- Second follow up (3–6 months post-discharge)
Pain severity is assessed using the PROMIS-29 survey, with tailored interventions for mild, moderate or severe pain. The pathway promotes safe opioid tapering, improved patient education and alternative self-management strategies.
Aim
The pain pathway is designed to support clinicians to reduce the risk of acute pain progressing to chronic pain beyond 3 months and to minimise the ongoing use of opioids in trauma patients. It guides clinicians in delivering safe, effective and holistic care.
This pathway promotes:
- safe and effective pain self-management
- clear communication by trauma clinicians with general practitioners and community services
- a holistic approach to care that considers psychosocial factors.
The pathway aims to ensure patients are:
- prepared and informed to manage injury-related pain at home
- able to increase function gradually
- able to appropriately use prescribed analgesics and have the confidence to reduce them, when appropriate
- competent in managing pain without needing to return to hospital.
Ultimately, patients should have:
- confidence in managing pain with analgesics and structured paced exercise
- improved quality of life through appropriate pain management
- understanding of the risks of long-term analgesic use.
Culturally safe care
ITIM is committed to working with the NSW trauma network to strengthen culturally safe care for Aboriginal people. This will involve:
- using culturally appropriate language and imagery
- including clear pathways for culturally safe assessment, treatment and follow-up care
- providing information for families and carers to support healing and recovery
- ensuring clinical content reflects holistic models of health and wellbeing.
Evidence
A review of the evidence was completed as part of the development of the Trauma Pain Pathway, based on the question:
What is the best pain management strategy for patients with severe injury at the time of discharge from the hospital to reduce pain severity and enhance their functional outcomes three months after discharge from the hospital in comparison with treatment as usual?
The bibliography outlines the academic and grey literature sources that were used to inform the development of this resource.
Ahmadi A, Bazargan-Hejazi S, Heidari Zadie Z, et al. Pain management in trauma: A review study. J Inj Violence Res. 2016 Jul;8(2):89–98. doi:10.5249/jivr.v8i2.707.
Agency for Clinical Innovation. Care delivery models for chronic pain: Evidence series. Sydney: Agency; 2023 [cited 2025 Nov 25]. Available from: aci.health.nsw.gov.au/__data/assets/pdf_file/0008/689615/ACI-Care-delivery-models-for-chronic-pain-evidence-series.pdf
American College of Surgeons. Best practices guidelines for acute pain management in trauma patients. Chicago, IL: American College of Surgeons; 2020 [cited 2025 Nov 25]. Available from: www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf
Australian and New Zealand College of Anaesthetists (ANZCA). Acute pain management: Scientific evidence. Melbourne: ANZCA; 2025 [cited 2025 Nov 25]. Available from: www.anzca.edu.au/safety-and-advocacy/advocacy/college-publications/acute-pain-management-scientific-evidence
Australian Commission on Safety and Quality in Health Care. Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard – Acute care edition. Sydney: ACSQHC; 2022. ISBN: 978-1-922563-80-4.
Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. Canberra: AIHW; 2018. Cat. no. HSE 210. ISBN: 978-1-76054-436-2 (PDF), 978-1-76054-437-9
Baldwin LM, Katers LA, Sullivan MD, et al. Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization. Trauma Surg Acute Care Open. 2023;8(1):e001038. doi:10.1136/tsaco-2022-001038.
Bernardo C, Hoon E, Gonzalez-Chica DA, et al. Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach. BMC Prim Care. 2024;25(1):167. doi:10.1186/s12875-024-02421-5.
Bureau of Health Information. Readmission and return to acute care following hospitalisation for eight clinical conditions, July 2015 – June 2018. Sydney (NSW): BHI; 2020. State Health Publication Number: (BHI) 200018.
Coombes J, Holland AJA, Hunter K, et al. Discharge interventions for First Nations people with injury or chronic conditions: A protocol for a systematic review. Int J Environ Res Public Health. 2022;19(18):11301. doi:10.3390/ijerph191811301.
Dobscha SK, Clark ME, Morasco BJ, et al. Systematic review of the literature on pain in patients with polytrauma including traumatic brain injury. Pain Med. 2009;10(7):1200–17. doi:10.1111/j.1526-4637.2009.00721.x.
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Goldsmith H, Curtis K, McCloughen A. Incidence, intensity, and impact of pain in recently discharged adult trauma patients: An exploratory study. J Trauma Nurs. 2017 Mar-Apr;24(2):102–9. doi:10.1097/JTN.0000000000000273.
Goldsmith H, McCloughen A, Curtis K. The experience and understanding of pain management in recently discharged adult trauma patients: A qualitative study. Injury. 2018 Jan;49(1):110–6. doi:10.1016/j.injury.2017.09.027.
Goldsmith H, McCloughen A, Curtis K. Using the trauma patient experience and evaluation of hospital discharge practices to inform practice change: A mixed methods study. J Clin Nurs. 2018 Feb;27(7–8):1589–98. doi:10.1111/jocn.14230.
Institute for Clinical Systems Improvement (ICSI). Pain management interventions. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2025 Nov 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553030/
Jadhakhan F, Evans DW, Falla D. The role of post‐trauma stress symptoms in the development of chronic musculoskeletal pain and disability: A systematic review. Eur J Pain. 2023;27(2):183–200. doi:10.1002/ejp.2048.
Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review. Br J Sports Med. 2020;54(2):79-86. doi:10.1136/bjsports-2018-099878.
NPS MedicineWise. Chronic pain [cited 2025 Nov 25]. Available from: hwww.nps.org.au/professionals/chronic-pain
Punches BE, Stolz U, Freiermuth CE, et al. Predicting at-risk opioid use three months after ED visit for trauma: Results from the AURORA study. PLoS One. 2022;17(9):e0273378. doi:10.1371/journal.pone.0273378.
Qaseem A, Wilt TJ, McLean RM, et al. Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367.
Roberts M, Brodribb W, Mitchell G. Reducing the pain: A systematic review of postdischarge analgesia following elective orthopedic surgery. Pain Med. 2012;13(5):711–727. doi:10.1111/j.1526-4637.2012.01359.x.
Rucinski K, Crecelius C, Cook JL, et al. Predictors of pain management outcomes following orthopaedic surgery: A systematic review. Musculoskeletal Care. 2024;22(4):e70002. doi:10.1002/msc.70002.
Silva Guerrero AV, Setchell J, Maujean A, et al. "I've learned to look at things in a different way": exploring patients' perspectives on participation in physiotherapist delivered integrated stress inoculation training and exercise for acute whiplash. Disabil Rehabil. 2022;44(18):5191-5198. doi:10.1080/09638288.2021.1931480.
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Smits EJ, Gane EM, Brakenridge CL, et al. Expert consensus and perspectives on recovery following road traffic crashes: A Delphi study. Disabil Rehabil. 2022;44(13):3122-3131. doi:10.1080/09638288.2020.1855677.
Stanley B, Collins LJ, Norman AF, et al. Opioid prescribing in the emergency department of a tertiary hospital: A retrospective audit of hospital discharge data. Emerg Med Australas. 2020;32(1):33-38. doi:10.1111/1742-6723.13331.
The Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain management. East Melbourne: RACGP; 2017. ISBN: 978-0-86906-483-2.
Wake E, Ranse J, Marshall AP. Scoping review of the literature to ascertain how follow-up care is provided to major trauma patients post discharge from acute care. BMJ Open. 2022;12(9):e060902. doi:10.1136/bmjopen-2022-060902.
Waler N, Anitescu M. Pain management strategies in orthopedic extremity trauma. Int Anesthesiol Clin. 2021;59(2):48–57. doi:10.1097/AIA.0000000000000319.