Referral criteria

Referral Criteria for Alder Hey Chronic Pain Service

Aims & objectives of the service

• To provide a specialist multidisciplinary approach to the diagnosis and management of chronic pain in CAYP and their families.
• Put in place a patient specific management plan which aims to reduce pain, improves functional ability and reduce the socioeconomic burden of pain for the family.
• We aim to promote the highest possible quality of life for CAYP with pain and pain associated disability, whilst promoting independence and wellbeing for patients through the provision of structured self-management support and pain rehabilitation, with a view towards fewer inappropriate medical appointments and readmissions.

Referral criteria

Patient age is 16 years or under.

Pain has persisted or been recurrent for 3 months or greater.

Referrals from secondary care and tertiary care once appropriate investigations in relation a diagnosis of presenting pain, or for exclusion of medical causes, have been completed; and it is considered that highly specialised resources and advice are indicated.

GP referrals will be considered when a paediatric secondary or tertiary opinion has been sought and provided. The outcome of this opinion is required to be included for the referral to be considered.

Examples of pain conditions referred for specialist paediatric pain management:

• Post-operative neuropathic pain
• Widespread pain / medically unexplained pain with significant disability
• Tumour related neuropathies
• Complex Regional Pain Syndrome
• Post amputation pain
• Specific disease related pain that has become unmanageable

Referrals from A&E will not be considered. Such patients need to be directed back to their GP or secondary/tertiary care consultant to consider completing a referral if the child’s pain is disabling and not well managed by their expertise.

Helpful information to include in referral to support triaging:

• Impact of Pain
  • School attendance
    • % attendance / home schooled
  • Degree of restriction on physical activity due to pain
    • Limiting sports participation/ limiting walking duration or mobility/ unable to climb stairs/ House bound/ Wheelchair bound/ Unable to do self-cares eg washing & dressing self/ Disability Living Allowance (DLA)
  • Mental health
    • Effect of pain on mood & emotions/ known to CAMHS or other MH services/ history of self-harm
    • Environmental stresses eg bullying; bereavement; family dynamics; family breakdown
• Current analgesic medication
  • All appropriate simple analgesics should have been considered and utilised using the WHO analgesic ladder. Please describe current analgesia regimen
  • Is patient currently using strong opioid medication eg morphine, oxycodone, tramadol?#
  • Is patient on neuropathic analgesic medication eg gabapentin/ pregabalin/ amitriptyline?
• Investigations – typically these should have been completed and communicated to family.
  • Are there any outstanding investigations?
    • If yes – what investigations are outstanding?
  • Are there other outstanding referrals or opinions being sought or still awaiting in relation to the same painful condition?
    • If yes – who has the patient been referred to or seen by?

Has the patient and family been given an explanation of the multidisciplinary pain management service? (can include a link to the clinic patient information leaflet here or to the webpage)

Are the patient & family in agreement with the referral?

If this referral is being completed by someone other than consultant or GP – please name responsible consultant for the patient’s ongoing care, and who this referral has been discussed and agreed with?