The Pain Clinic offers a comprehensive and specialised assessment for pain with a wide range of treatment and management options available, including both non-invasive and invasive procedures, and advice on medication. Persistent pain (also known as chronic pain) is a complex condition and can be associated with a wide range of causes, some of which are difficult to identify. We know that patients experience real pain despite having normal scans and tests. It is often difficult to completely relieve persistent pain. Our aim is to alleviate the pain as much as possible and to improve quality of life and to assist patients with self-management of their pain.
While we try to make a full and appropriate assessment of the patient’s pain and to ensure that an important diagnosis has not been missed, the Pain Management Service is not primarily a diagnostic centre. For patients with rheumatological symptoms, where a diagnosis has not yet been made, it may be more suitable for them to be seen by a Rheumatologist first. For other conditions, notably headache and pelvic pain, we would kindly ask the GP to refer patients to The Headache Group at UCLH, and the UCLH Pain Management Centre respectively. Recent onset of back pain +/- sciatica should be assessed for Red Flags, and where appropriate, referred initially to Musculoskeletal Physiotherapy or the Musculoskeletal Clinical Assessment and Treatment Service (MSK CATS).
Referrals for Acupuncture and Psychology Services, including the Pain Self-Management Programme, are made within the Pain Clinic, if appropriate, after assessment of the patient. We are unable to accept direct referrals for Acupuncture, unless a PoLCE (Procedures of Low Clinical Effectiveness) approval has been obtained by the GP.
Referrals to the Whittington Pain Management Service are mainly from GPs and Secondary Care Specialists, as well as from MSK CATS. However, before referring to the service, referrers should ensure that:
- Appropriate diagnostic investigations in other specialties as appropriate have been exhausted
- The pain has been assessed, particularly as to whether there is an element of neuropathic pain, and treated accordingly – see Neuropathic
- Pain Treatment Pathway
- First line intervention have been tried:
- Optimise analgesia
- Consider TENS
- Consider Physiotherapy
- Advice on self-management
- Address common misconceptions
- The patient has been encouraged in self-management approaches and that appropriate expectations have been given to the patient (e.g. do not refer patients to have an injection)
- Mood and sleep have been assessed and treated appropriately
Appropriate Conditions for Referral:
- Patients with complex chronic pain problems (e.g. persistent back pain +/- sciatica, difficult cancer pain, fibromyalgia, phantom limb pain, complex regional pain syndrome, poorly controlled trigeminal neuralgia), and where other interventions have failed
- Patients exhibiting disabling levels of distress, depression or anxiety that significantly impair their function
- Analgesic advice or guidance, especially where strong opioids are being considered
- Consideration of other specialist pain intervention (e.g. injections)
- To help patients come to terms with and cope better with persistent pain, possibly as preparation for referral to Pain Self-Management.
Inappropriate Conditions for Referral:
- Some conditions are not considered appropriate for initial referral, as further specialist assessment or investigations may be needed. It is the responsibility of the referring clinician to decide whether an initial referral to the Pain Management Service is appropriate, or whether to refer to other services
- New onset of neurological symptoms or signs (e.g. progressive motor deficit)
- Red Flag pathologies (e.g. cauda equina syndrome, infection, recent trauma)
- Inflammatory conditions, such as suspected connective tissue disorders, polyarthropathies or ankylosing spondylitis (consider initial referral to Rheumatology)
- Headache disorders (please refer to The Headache Group at UCLH)
- Pelvic pain (please refer to the UCLH Pain Management Centre)
Information to be included in the referral
Please include reason for referral, and any relevant information about pain history, investigations performed and the results of these, PMH including relevant psychosocial history, previous treatments tried and the response to them, current medication and allergies.
If you are aware of repeated referral, mention this in the letter as they would benefit from MDT discussion.