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Scarborough Pain Service (formerly Clinical Enablement Service) – Information for GPs

Referral Criteria / Commissioning position

Pain and pain management may be defined in the following ways:

  • An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (Merskey and Bogduk 1994)
  • Chronic pain is pain of more than 12 weeks duration or pain that continues after the expected period of healing.

Pain management is any intervention designed to prevent or alleviate pain and/or its impact, such that quality of life and ability to function are optimised.

The Scarborough Pain Service follows a stepped-care model, empowering patients with chronic pain to self-manage and improve their quality of life, through psycho-education and input from a psychology-led multi-disciplinary team (physiotherapy and OT).

The pain service offers individual assessment and input, and a range of courses:

 

First Steps: Psychoeducational course aimed at understanding/self-managing pain

Walking: Physiotherapy led, to help patients safely increase their confidence with exercise

Gym: Physiotherapy-led, to give patients the confidence to exercise

Relaxation: A Cognitive Behavioural Therapy course teaching relaxation techniques

Mindfulness: Meditative techniques for managing pain / sleep / mood

Moving on: Acceptance and Commitment Therapy group helping patients manage the emotional impact of chronic pain

Making changes: Occupational therapy led course for patients wishing to re-engage with activities and work

Sleep: Practical ways of improving sleep

 

Refer patients with persistent, chronic pain (see definition above), when the pain has been investigated and surgical and medical treatments have been maximised.

Patients with suspected Fibromyalgia and Chronic Fatigue should also be referred to the service, please refer to the guidance located here.

Patients who need clinical investigation should be referred to the appropriate secondary care specialty.

Patients should expect an assessment appointment, followed by an individually tailored plan.  Individual appointments are held in Scarborough and Malton hospitals and the courses run in easily accessible community venues in Scarborough, Filey and Malton.

Investigations prior to referral

All necessary physical investigations

Exclusions and appropriate referral route

Suspected Fracture / Infection > Urgent care/Emergency department

Ante-natal Back Pain/Pelvic Pain > Physiotherapy/Women’s health

Chronic Fatigue Syndrome (unless primary presenting symptom is pain of 3/12 duration) > Specialist service – Hull/Harrogate/South Tees

Presence of red flags i.e. cauda equine syndrome > Emergency Department

Patients receiving care from another pain management service

Patients under the age of 18 years > Paediatrics

Patients not registered with an SRCCG GP

Patients requiring a surgical opinion > Appropriate surgical specialty

Hospital in-patients > Secondary care pain service

A patient with uncontrolled alcohol and/or substance misuse > Appropriate support service

A patient with uncontrolled psychotic or other major psychiatric illness > Appropriate mental health support service

Post-surgical or post cancer pain > Secondary Care Pain service

Acute pain > Secondary Care Pain service

Palliative care patients

Information to include in referral letter

  • Description of symptoms and duration and diagnosis if relevant
  • Details of treatments and measures tried including outcomes
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Mental health history
  • Current regular medication
  • BMI and smoking status
  • Alcohol consumption
  • Ethnicity
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