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Difficulties in managing chronic pain (in particular complex pain patients with many co-existing diseases, multiple different medications, kidney and liver failure)

  • Need of non-pharmacological treatments, Medication not effective
  • In the presence of yellow flags (risk of long-term distress, disabling pain)
  • Children, Elderly
  • Complex Cancer Pain
  • Refractory abdominal, renal and post-surgical pain
  • Resistant trigeminal neuralgia and postherpetic neuralgia
  • Complex Regional Pain syndrome

To be able to triage patients appropriately, the following information should be provided in a referral letter: (mnemonic: SOCRATES)

S – Site and side

O – Onset (sudden, gradual, when)

C – Character (nociceptive, neuropathic, mixed)

R – Radiation (into arms, hands, legs, feet)

A – Associated symptoms (Sleep deprivation, tiredness, depression)

T – Time course / pattern (at rest, with activity)

E – Exacerbating / relieving factors

S – severity (range on pain scale 0-10 / 10, constant or intermittent)

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