Criteria for referral to public hospital health independence program services

Persistent or chronic pain following cancer treatment (e.g.  chemotherapy-induced peripheral neuropathy, abdominal visceral pain, neural injury) with all of the following:

• > 3 months duration with symptoms that impact on daily activities including impact on work, study, school or carer role
• ongoing or escalating analgesia needs despite adequate trial of treatment in previous 3 months (exercise and analgesia)
• adequate trial of treatment (exercise and analgesia)
• at risk of functional or psychological deterioration, or medication dependence
• willing to explore living well with pain and is willing to learn to self-manage ongoing pain.

Information to be included in the referral

Information that must be provided

• Pain history: onset, location, nature of pain and duration
• Details of surgery, chemotherapy or radiotherapy treatment that may have caused the pain
• Psychological status and cognitive function
• Details of previous pain management including the course of treatment(s) and outcome of treatment(s)
• Comprehensive past medical history
• History of alcohol, recreational or injectable drugs, or prescription medicine misuse
• Current and complete medication history (including non-prescription medicines, herbs and supplements).

Provide if available

• Details of functional impairment
• Psychiatric history
• If the person has symptoms of, or have been diagnosed with, post-traumatic stress disorder (PTSD)
• Details of any current behaviours that may impact on the person’s ability to participate in a chronic pain management program (e.g. behaviours of concern, level of alcohol intake, cognition issues, reliance on a carer, mental health issues)
• If the person has been identified as having high-risk circumstances (multiple provider episodes, high-risk drug combinations, or opioid dose threshold) through SafeScript
• Results of previous investigations
• If the person has previously completed a chronic pain management program and if so the provider of the program
• If a medication review or assessment is required
• If the person is part of a vulnerable population.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

The Health Independence Program chronic pain service is a multidisciplinary service focused on exploring how to self-manage to live well with the presence of persistent or chronic pain. These referral criteria identify the patients most likely to benefit from this type of intensive service. A different service should be considered for patients who do not meet these referral criteria. Patients that only require procedures or medical interventions (e.g. nerve blocks) should be referred to an acute pain clinic.

Public hospitals can provide services that see both public and private or compensable patients through the same clinic, in the same physical location. The referral should note if the patient is eligible for compensable services (e.g. through the Transport Accident Commission of WorkSafe).

Vulnerable populations include

• people from culturally and linguistically diverse backgrounds
• older Australians
• carers of people with chronic conditions
• people experiencing socio-economic disadvantage
• people living in remote, or rural and regional locations
• people with a disability
• people with mental illness
• people who are, or have been, incarcerated.

Vulnerable patient groups also include: terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital health independence program service is not appropriate for

• Patients that are currently not willing to explore living well with pain and not willing to learn to self-manage ongoing pain
• Patients currently receiving treatment for cancer
• Patients currently undertaking another chronic pain management program
• Patients that have already completed a multidisciplinary, comprehensive chronic pain management program or service for the same identifiable cause of pain where their clinical symptoms, or their readiness to undertake a chronic pain management program, remains unchanged
• Patients who only want an intervention such as an injection or dry needling
• Patients who want to receive services as a compensable patient should not be referred to health service that only provides publicly funded services.