Use these principles and patient classification when you receive a referral to your chronic pain clinic.
Guiding principles
- Triage the referral for:
- appropriateness
- fit with the service model
- readiness of the patient to participate in the service model.
- It may be necessary to provide assessment and referral onto addiction medicine, mental health or primary care services with support and a suggested management plan.
- The role of tier 2 clinics is to assess, triage and identify potential need to refer to tier 3 clinics when complexity is high or resources insufficient.
- Provide referred patients with an assessment and management plan in the pain management clinic that is located closest to their place of residence, including paediatrics, especially for those living in rural areas. If it is not likely that the person will benefit from the service type available at the specific clinic (e.g. they require a high intensity program or intervention than cannot be provided, consultation for implant or specific paediatric interventions) they should be referred to the clinic that provides this service within their geographic sector as per the service flow.
Tier 2 and 3 services are defined on the service flows page. Classification of adult patient complexity on initial presentation to a service.
Classification of adult patient complexity on initial presentation to a service
This information is to assist with communication and understanding across the pain network community. It has not been validated and is intended to be used flexibly.
Domain | Low | Moderate | High |
|---|---|---|---|
Pain intensity | <5 on Brief pain inventory (BPI) | 5-8 on BPI intensity | >8 on BPI intensity |
Pain interference | <5 on BPI interference | 5-8 on BPI interference | >8 on BPI interference |
Depression | <14 on Depression, anxiety and stress scale (DASS) | 14-20 on DASS | >20 on DASS |
Pain self-efficacy | >35 on Pain self efficacy questionnaire (PSEQ) | 20-35 on PSEQ | <20 on PSEQ |
Catastrophising | <20 on Pain catastrophising scale (PCS) | 20-30 on PCS | >30 on PCS |
Reliance on medication | Simple analgesics, Non-steroidal anti-inflammatory drugs, antidepressants, anxiolytics, low level anticonvulsants, sleeping tablets, occasional opioid use (e.g. Panadeine Forte 1-2 daily, 1 Endone prn) | As for low, plus low to moderate regular opioid use: 20-50 morphine equivalent daily or 6-8 Panadeine Forte | As for moderate plus higher level regular opioid use: >50mg morphine equivalent |
Employment | Able to work with pain | No current employment or difficulty maintaining employment due to pain (reduced hours, modified or light duties) | No current employment due to pain |
Mental health | No other relevant psychiatric diagnosis | May have other psychiatric diagnosis (e.g. eating disorder, bipolar) but stable and well managed (stable medication regime and appropriate mental health care) | Has other psychiatric diagnosis and not well managed (not on stable medication regime or not under appropriate mental health care) |
Willingness to change | Understands importance of active self-management and willing to practice and learn. Keen to reduce reliance on medication and other passive strategies | Open to active self-management but also still seeking cure, medical intervention and/or stronger medications | Only interested in cure or medical intervention. Not open to active self-management approach |
Co-morbidity | No co-morbid condition | 1-2 co-morbidities | >2 co-morbidities |
Opioid conversion to oral morphine equivalent daily dose (oMEDD)
Use these resources from the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists to convert opioids to oral morphine.