Service Overview - NBT & UHB
Pain clinics in local trusts are currently under great pressure to manage demand. The local pain clinicians have advised GPs to try to manage pain in primary care initially. For advice on management in primary care and when to refer please see Referral Guidelines produced jointly by the Clinical Lead at NBT and the Senior Pain Clinician at UHB.
If referral is required then please consider the following guidelines/referral options which may be more suitable for a patient than pain clinic:
- Self management program
- Back Pack via e-referral
- Opioid use and reduction- Local pain clinics get a lot of requests for advice on use of opiates for chronic pain and in particular how to reduce them. See Guidelines for Opioid Reduction in Primary Care that were developed by Oxford University Hospital but are also advised and referenced by local pain clinicians. Thanks go to OUH for access to these guidelines.
If referral to pain clinic is still required then please consider the following notes or check the trust web pages (see links below).
The aim of the Pain Clinic is to:
Provide a joined up, multi-professional patient specific assessment and put in place an individual management plan, enabling patients to lead a more normal life with reduced disability.
Develop an individual management plan with psychological and behavioural support if required to help patients live a fuller life in spite of pain. There may be different drugs/medication or injections that can help, but even if this is an option many people still need help to manage their pain so that they can Increase social and physical functioning with reduced disability. The pain clinic works to support both patients and GPs in managing pain.
Promote self-management, with related benefits of fewer inappropriate medical appointments and re-admissions.
More detailed information is also included in the BNSSG Chronic Pain Guidelines Oct 2013.
Referrals should be made via e-referral. The Bristol Referral Service or the Pain Clinic may return a referral without the relevant supporting information:
History of pain problem
Primary source of pain
Reason for referral to the pain clinic (quality of life issues, sleep difficulty, work, depression, medicines management)
The doctor’s and the patient’s expectation
Treatment of pain so far including medication, surgery, injections, physiotherapy, TENS, acupuncture
Relevant investigations with results e.g. blood tests, X-rays, scans
Whether the patient has previously been seen in a Pain Clinic, dates and hospital
Other relevant medical problems and medication
Mental health issues or drug/alcohol dependency
Alternatively use the proforma accepted by both UHB and NBT.
Please do not refer to the Pain Clinic if the patient has been referred to another specialty for the same presenting complaint.
If a patient has been seen in any Pain Clinic in the past 2 years please e-mail PainClinicClinical@nbt.nhs.uk to request advice about further management, including details of where the patient was seen and by whom if possible. Local pain clinicians advise: 'If a patient has completed all available therapies it is unlikely we will be able to offer any further advice unless there is a new problem. Repeated reviews of these patients is not helpful for them and reduces the available appointments for patients who may benefit from our service.'
Referrals to Self Management Program
Click on link for criteria for referral to the Pain Self Management Program (SMP). In order to refer to the Pain Self Management program run by Dr Nick Ambler, Clinical Psychologist, you will need to refer directly by sending a letter to the address below:
Dr N Ambler, The Lodge, Cossham Hospital, Kingswood, Bristol, BS15 1LF
Referral Guidance - Nuffield
Nuffield Health Hospital provides NHS Pain Treatment. Refer to Nuffield's guidelines on conditions treated and procedures performed.
The option of Nuffield will be offered to patients when appropriate. Please include the minimum referral information or use the proforma attached in the section above.
If you just need advice on management or aren't sure if referral is appropriate then you can email the pain team directly at NBT PainClinicClinical@nbt.nhs.uk