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Child Health Guideline Identifier

Pain - referral to the paediatric pain service

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Introduction

The Paediatric Pain Management Service provides input and support across the hospital for a child and their family experiencing acute, complex or procedural pain.

Acute Pain Service

The Acute Pain Service receives referrals for the management of acute postoperative pain for a child or young person who is prescribed one or more of the following pain management modalities in theatre:

  • Patient Controlled Analgesia (PCA)
  • Continuous Analgesia Infusions
  • Nurse Controlled Analgesia (NCA)
  • Epidural Infusions/Patient Controlled Epidural Analgesia (PCEA)
  • Regional Infusions

Prior to discharge from the Post Anaesthetic Care Unit (PACU), a child's details are recorded on a pain referral form (CR4091) which is then collected by the Pain Service.

A child started on a pain modality by PICU or requiring a pain modality on discharge to the ward from PICU should be referred to the Pain Service by the PICU registrar.

A referral to the acute pain service for management of acute pain due to medical conditions should be made by a senior member of the child's medical team to the pain registrar. This should be followed up by a written referral using internal referral form (CR2679) which should be faxed to the Anaesthetic Department.

In all cases, the child's primary consultant should be consulted prior to the acute pain service referral.

A child is discharged from the service once the pain management modality is discontinued and the primary medical team can effectively manage the prescribed analgesic regime.

A child with complex or persistent pain conditions will not be managed by the acute pain service.

Acute pain service referral pathway

Acute referral pathway

Complex pain service

The Complex Pain Service (CPS) at Starship Child Health provides an outpatient based rehabilitation approach to the care of a child with persistent or complex pain problems.

Clinics

Interdisciplinary clinics are held for new patients and follow-up cases.

Referrals

Referral to the CPS should be made using an internal referral form (CR2679) or clinic letter. This should be sent to Clinical Director of Complex Pain and Paediatric Palliative Care Services via letter or fax.

Referrals are triaged according to the impact the pain is having on the child's daily function. Information on the child's activities of daily living, school attendance, psychological wellbeing and their current management plan is required to aid appropriate triaging.

Child or young person with acute complex pain

The Pain Service considers a child as having a complex pain problem when:

  • Pain is difficult to control or persists for a prolonged period after surgery
  • They experience pain without an adequate cause being determined after appropriate examination and investigation
  •  Certain medical conditions result in pain that is difficult to control

Referrals

If a surgical or medical team would like a child with complex pain to be reviewed by the Pain Service, then a written out patient referral will be required from the attending consultant or delegated senior registrar or fellow.

Complex pain service referral pathway

chronic referral pathway

Procedural pain

A child in hospital is often subjected to frightening and painful procedures.

The pain nurse specialists can be contacted Monday to Friday to provide support and advice for pharmacological and non-pharmacological options.

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Document Control

  • Date last published: 23 December 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Pain Service
  • Author(s): Paediatric Pain Nurse Specialists
  • Owner: Paediatric Pain Service
  • Editor: Greg Williams
  • Review frequency: 2 years

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