Patients referred for new assessment may have any of the many types of pain.
- Some have recent onset or acute pain (eg. pain associated with vascular ischaemia; severe acute shingles pain; acute presentations of cancer pain, etc).
- Others have subacute pain or pain that has persisted for several weeks. Examples include: complex regional pain syndromes (CRPS); persisting post-surgical and post trauma pain (often due to nerve injury); non-specific spinal pain (back pain).
- Many have persisting or chronic pain (lasting more than 6 months). Such pain may be almost constantly present (eg. back pain) or recurring (eg. headaches). Regardless of the original cause, chronic pain can continue to be troubling and interfering in daily life.
The assessment process involves a comprehensive, multidisciplinary assessment which requires the patient to attend the Centre for up to 6 hours on one day.
- a consultation with a Pain Medicine Specialist
- a consultation with either a psychiatrist or clinical psychologist specialised in pain
- a detailed musculoskeletal examination by a physiotherapist specialised in pain assessment and management
A multidisciplinary case conference is held by the assessment team on the day of the initial assessment. This conference is aimed at developing a comprehensive understanding of a patient's pain and associated problems. Treatment recommendations are also decided. After the case conference, the patient has a feedback session with the Pain Medicine Specialist to discuss our findings and treatment recommendations. A detailed report that summarises our findings and recommendations is prepared and sent to the referring doctor or agency.
To ensure we make best use of the assessment time, it is our policy that:
- Prior to being given an appointment for assessment, all referred patients must complete an information booklet (sent out by post), with details of prior medications, operations, other treatments, and their medical history (eg. other illnesses)
- Patients should try to arrive at the Centre as early as 8 am and allocate the entire day
- A spouse, a close relative or friend should accompany the patient (for support and additional information)
- All prior X-rays (relating to the presenting pain problem), other investigation’s reports, prior specialist reports, and all current medications must be brought to the Centre on the assessment day
The majority of patients referred to PMRC have had many specialist consultations to identify a clear diagnosis for their pain. To avoid duplication of previous investigations, it is important the PMRC specialists have access to reports of these earlier investigations. This will speed up our assessment processes.
However, in some cases, it will be decided that further consultations are needed with appropriate specialists. It is a Centre policy that no treatments are started until every reasonable step has been taken to explore the underlying factors contributing to the pain.
In some patients this may require the following additional measures to be taken:
- Further imaging studies such as MRI, CT
- Nerve conduction studies
- Diagnostic nerve blocks such as medial branch blocks, coeliac plexus block, etc
- Diagnostic intravenous infusions such as lignocaine
- Psychiatric/Clinical psychology extended review
- Drug and Alcohol review