Chronic visceral pain

Red flags

Refer to alternate diagnostic services.

  • Unexplained weight loss
  • Previous or suspected malignancy
  • Unexplained alteration in bowel habit

The following may lead to more urgent categorisation

  • Severe symptoms despite optimum management
  • Escalating opioid dependency

Chronic visceral pain includes:

  • Pelvic pain
    • Endometriosis
    • Chronic PID
    • Post-surgical/trauma
  • Abdominal pain
    • Adhesions
    • Inflammatory bowel disease
    • Post-surgical/trauma pain

These conditions should be fully investigated and referred to Gynaecology/General Surgery before considering PPMS referral.

Other important information for referring practitioners

Lifestyle changes

  • Encourage healthy activity within pain limits
    • Consider physio/exercise physiologist referral
    • Hydrotherapy
  • Ensure adequate sleep
  • Check for mood disturbances and relationship difficulties
    • Consider psychology referral for any associated mood disturbances and to assist in pain control

Medical management

  • Optimise medical management of predisposing secondary condition (if present)
  • Set realistic goals
  • Treat associated mood disorders
  • Avoid over-reliance on medication, encourage self-management and set realistic goals for treatment
    • Transcutaneous electrical nerve stimulation (TENS)
    • If trialling medication start at low dose and titrate upwards
    • Agree on trial period for medication
    • Try to avoid opioid medication – only use opioid drugs for exacerbations and set time limits on prescribing

Referral requirements

A referral may be rejected without the following information.

  • Persistent Pain Management Service eReferral form
  • Reason for referral
    • Comprehensive multidisciplinary management plan
    • Specific concerns regarding medication overuse/dependence
    • Need for focused multidisciplinary approach
  • History of condition
    • Date of onset and timeline
    • Any cause identified for pain
    • Surgery if relevant
    • Management of condition.
    • Treatments trialled and reasons for failure
    • Include relevant specialist letters (especially if previously seen at another pain clinic)
  • Current and previous relevant medical and mental health conditions
  • Current medications and previous medications trialled for pain
  • List drug dependencies, inappropriate drug use and prescribed drug misuse e.g. nicotine, alcohol, cannabis, opioids
  • Allergies
  • Relevant examination findings
    • Associated tenderness
  • Investigations
    • Relevant imaging e.g. ultrasound, other

Additional referral information (useful for processing the referral)

  • Investigations related to co-morbidities e.g. diabetic control, malignancy, other
  • Preferably patient to complete an entry patient questionnaire prior to first consultation

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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