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Patient assessment

Assessments

Patients referred for new assessment include those with acute conditions such as pain associated with vascular ischaemia; severe acute shingles pain; acute presentations of cancer pain etc; subacute pain eg complex regional pain syndromes (CRPS); persisting post surgical and post trauma pain; also other presentations of persisting pain which our Centre has now identified as being important opportunities for early intervention and prevention of progression to a chronic phase; chronic pain and cancer pain.

The assessment process involves a comprehensive multidisciplinary assessment which requires the patient to attend the Centre for an entire day.

Assessments include:

  • a one hour consultation with a Pain Medicine Specialist
  • a consultation with either a psychiatrist or clinical psychologist specialised in pain
  • a detailed musculoskeletal examination by a physical therapist with special training in pain assessment.

Some patients may also require assistance from our social worker.

Following the initial assessment, we may ask for additional review from other specialists associated with the Centre which include rehabilitation medicine, neurosurgery, orthopaedic surgery, oncology, rheumatology, etc.

A multidisciplinary case conference is held on the same day of the initial assessment with the aim of developing a comprehensive problem list and treatment recommendations. On the afternoon of this assessment day, the patient has a feedback session with a designated case manager. A detailed report is then generated summarising our findings and recommendations and this is sent to the referring doctor or agency expeditiously.

Special requirements for patients attending assessments are related to the complexity of pain problems and the need to optimise the time available.

Special requirements are:

  • patients should expect 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;
  • the Centre questionnaire with details of prior medications, operations, illness, etc, must be completed;
  • all prior X-rays, other investigation’s reports, prior specialist reports, and all current medications must be brought to the Centre as a key component of our assessment
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Diagnosis

The majority of patients referred to PMRC have had a large number of specialist consultations in order to have a clear diagnosis concerning the underlying cause of their pain. This is why it is very important for patients to present copies of all previous consultations. On the basis of this information, PMRC specialists will often decide that adequate steps have been made to obtain a clear diagnosis.

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.
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