Referral Criteria

Cardiff and Vale University Health Board

Chronic Pain Clinic Referral Inclusion and Exclusion Criteria

Purpose

This document outlines the referral criteria for the Cardiff and Vale University Health Board Chronic Pain Clinic. It aims to support appropriate and timely referrals by ensuring that sufficient clinical information is provided for effective triage and that patients are directed to the most appropriate service based on their clinical needs. Referrals will be reviewed against the inclusion and exclusion criteria outlined below

CAV Pain Clinic - Inclusion and Exclusion Criteria
Inclusion Criteria	Exclusion Criteria
Referrals will be considered if all of the following criteria are met: Age: ≥ 18 years Pain Duration: ≥ 3 months Clinical Condition: Chronic pain where treatable or reversible causes have been excluded. Investigations: Appropriate investigations completed, including exclusion of red flags (e.g. back pain in patient with a history of malignancy). Primary Care Management: Optimised management in Primary Care, including: Relevant medication trials. Non-pharmacological strategies (e.g. Physiotherapy, self-management support). Referral Information: Comprehensive clinical details including: Pain history and duration. Previous treatments and response. Current and past medications. Relevant medical background. Functional impact. Patient goals and expectations. Multisite / Widespread Pain Referral will be considered where: Primary Care screening has been completed (e.g. RCGP Fibromyalgia screening tool). Fibromyalgia diagnostic criteria are met or alternative causes have been excluded. Appropriate baseline investigations have been performed (e.g. inflammatory, rheumatological, endocrine, or metabolic screening). Urgent Referrals If a referral is marked as ‘urgent’, the reason must be clearly documented. Referrals marked urgent without justification will be returned for further information. Pain Management Programme Referrals specifically requesting a Pain Management Programme (PMP) should either be submitted directly to the PMP service or clearly labelled at the top of the referral to facilitate prompt triage and allocation. Psychology Provision Please note: There is no dedicated psychology service within the CAV Pain Clinic. Where appropriate, referral to local mental health or psychological services should be arranged separately.	Referrals will not be accepted if any of the following apply: Multiple Simultaneous Referrals: Referrals to multiple specialities for the same condition without clear coordination. Insufficient Clinical Detail: Missing essential information required for triage. Previously Discharged for Same Complaint: Patient has already been assessed and discharged for the same pain condition. Age: < 18 years (unless formally agreed) Pain Duration: < 3 months Incomplete Investigation: Necessary investigations or red flag assessment not completed. Acute or Emergency Pain: Pain requiring urgent or emergency assessment. Red flags not evaluated: e.g. unexplained weight loss, night sweats, neurological deficit, recent malignancy. Medication-Only Referral: Referral solely for prescribing without evidence of optimised Primary Care management. Requests for non-formulary medications (e.g. Ketamine, Cannabis-based products, Naltrexone, Bupropion).

CAV Pain Clinic - Inclusion and Exclusion Criteria

Inclusion Criteria

Exclusion Criteria

Referrals will be considered if all of the following criteria are met:

Age: ≥ 18 years

Pain Duration: ≥ 3 months

Clinical Condition:

Chronic pain where treatable or reversible causes have been excluded.

Investigations:

Appropriate investigations completed, including exclusion of red flags (e.g. back pain in patient with a history of malignancy).

Primary Care Management:

Optimised management in Primary Care, including:

Relevant medication trials.

Non-pharmacological strategies (e.g. Physiotherapy, self-management support).

Referral Information:

Comprehensive clinical details including:

Pain history and duration.

Previous treatments and response.

Current and past medications.

Relevant medical background.

Functional impact.

Patient goals and expectations.

Multisite / Widespread Pain

Referral will be considered where:

Primary Care screening has been completed (e.g. RCGP Fibromyalgia screening tool).

Fibromyalgia diagnostic criteria are met or alternative causes have been excluded.

Appropriate baseline investigations have been performed (e.g. inflammatory, rheumatological, endocrine, or metabolic screening).

Urgent Referrals

If a referral is marked as ‘urgent’, the reason must be clearly documented.

Referrals marked urgent without justification will be returned for further information.

Pain Management Programme

Referrals specifically requesting a Pain Management Programme (PMP) should either be submitted directly to the PMP service or clearly labelled at the top of the referral to facilitate prompt triage and allocation.

Psychology Provision

Please note:

There is no dedicated psychology service within the CAV Pain Clinic.

Where appropriate, referral to local mental health or psychological services should be arranged separately.

Referrals will not be accepted if any of the following apply:

Multiple Simultaneous Referrals:

Referrals to multiple specialities for the same condition without clear coordination.

Insufficient Clinical Detail:

Missing essential information required for triage.

Previously Discharged for Same Complaint:

Patient has already been assessed and discharged for the same pain condition.

Age: < 18 years (unless formally agreed)

Pain Duration: < 3 months

Incomplete Investigation:

Necessary investigations or red flag assessment not completed.

Acute or Emergency Pain:

Pain requiring urgent or emergency assessment.

Red flags not evaluated: e.g. unexplained weight loss, night sweats, neurological deficit, recent malignancy.

Medication-Only Referral:

Referral solely for prescribing without evidence of optimised Primary Care management.

Requests for non-formulary medications (e.g. Ketamine, Cannabis-based products, Naltrexone, Bupropion).