What the Pain Clinic Offers - NHS Kernow Referral Management

What the Pain Clinic Offers
The pain clinic offers a bio-psycho-social assessment and approach to
helping patients manage chronic pain.
Often a combination of treatments may be used. Referrals for a specific
treatment (such as ‘an injection’) are often unhelpful – appropriate treatment
plans will be made according to a detailed assessment.
Biological approaches
Medication advice
Simple interventions such as TENS advice
Acupuncture as part of a management plan (up to 10 sessions only –
the expectation would be that ongoing treatment is provided in primary
Injections such as epidurals, facet joint injections and nerve root blocks
Complex neuromodulation interventions for lower limb neuropathic pain
Intrathecal pumps for spasticity
Psycho-Social approaches
Pain Management Programme (for musculoskeletal pain, neuropathic
pain and CRPS)
Specific exclusions include Fibromyalgia, abdominal pain, headache.
The pain management department does not have the capacity to offer
individual psychological treatment programmes (such as CBT).
When are spinal injections not likely to be helpful?
Where risks outweigh likely benefits (e.g. where body habitus or
comorbidities mean the injection cannot be performed safely)
When they work, injections typically offer a period of pain relief, which
should allow patients to engage with physiotherapy/weight
loss/exercise programmes. Failure to engage with these approaches
usually results in relapse of symptoms.
Long-term relief from injections is unlikely in patients whose symptoms
have been present for many years or who do not have an underlying
cause that will improve with time.
Psychosocial yellow flags and significant untreated psychological comorbidities are relative contraindications to injections as outcomes are
often poor.
When injections have previously failed to help.