Musculoskeletal pain

Red flags

  • Progressive pain
  • Night pain

The following may lead to more urgent PPMS categorisation

  • Severe lifestyle limiting symptoms
  • Escalating analgesic dependence (esp opioid)

These patients should be initially managed by treating the cause of their pain and will usually have seen an Orthopaedic specialist or Rheumatologist. Musculoskeletal pain includes:

  • Joint pain
    • Osteoarthritis
    • Rheumatoid arthritis (other rheumatoid diseases)
  • Bone pain
    • Osteoporosis
    • Paget’s disease of bone
    • Post fracture pain
  • Muscular pain

Other important information for referring practitioners

Lifestyle changes

  • Encourage healthy activity within pain limits
    • Consider physio referral
    • Hydrotherapy
  • Encourage weight loss if obese
    • Consider dietician referral
  • Ensure adequate sleep
  • Check for mood disturbances and relationship difficulties
    • Consider psychology referral for any mood disturbances and for pain management

Medical management

  • Set realistic goals
  • Use graded analgesia
  • Consider NSAIDs (ensure no contraindications and take care in elderly/renal failure/hypertensives)
  • Consider pain modifying drugs (tricyclics, duloxetine before escalating pain relief to opioids.
  • Exclude neuropathic pain (use DN4 questionnaire)
  • Consider Pregabalin if the pain has neuropathic features

Referral requirements

A referral may be rejected without the following information.

  • Persistent Pain Management Service eReferral form
  • Reason for referral
    • Management plan
    • Specific concerns re medication overuse/dependence
  • History of condition
    • Date of onset and timeline
    • Mechanism of injury (if relevant)
    • Management of condition including treatments trialled and reasons for failure
    • Include relevant specialist letters
    • Forensic or ongoing medicolegal issues
  • Current and previous relevant medical conditions
  • Current medications and past medications trialled for pain control
  • List drug dependencies, inappropriate drug use and prescribed drug misuse e.g. nicotine, alcohol, cannabis, opioids,
  • History of treatment within Alcohol and Drug Services or notifications to Medicines Regulation authorities
  • Allergies
  • Relevant examination findings and relevant specialist reports or opinions
  • Investigations
    • FBC, E/LFT, BS, CRP
    • Relevant imaging

Additional referral information (useful for processing the referral)

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

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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