Development of a Referral Tool for a Musculoskeletal Pain Management Service: A Service Improvement Project

Abstract

Objectives: To develop an evidence-based patient referral guidance tool for clinicians referring to a complex pain management service. 

Design: In this service development project, a three-phase, pragmatic qualitative approach was used: 1) a systematic scoping search of the literature was undertaken; 2) a focus group was completed with staff in a complex pain management service and a draft referral tool constructed informed by the focus groups and scoping review; 3) a round of expert feedback on the draft tool was obtained via email and used to refine the final tool.

Setting: The project took place in a complex pain management service in the North East of England.

Participants: Staff members from a complex pain management service and experts in the field of pain management were contacted to provide their input into this project.

Results: Phase One found that an aggregation of the following should prompt a referral to a specialist pain service: moderate-severe psychological distress; a diagnosis of fibromyalgia, chronic widespread pain, or complex regional pain syndrome; and that the individual has trialled a period of standard care before referral. Phase Two highlighted the difficulty in defining and identifying psychological distress and the absence of a universally accepted screening tool. Phase three provided feedback broadly supportive of the themes within the referral tool and clarified aspects of language and semantics.

Conclusions: This project succeeded in achieving its primary aim. The resultant tool suggests key referral criteria for a complex pain service. Future work should evaluate this new referral tool's impact on the performance of the complex pain service it was designed for and associated patient outcomes. Future work should also explore the generalisability of these findings to other pain services with a view to enhancing referral systems for pain services nationwide.