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