Chronic Pain Clinic (CPC)

CPC is part of the Health Independence Program and subject to Statewide Referral Criteria (SRC) for public specialist clinics as outlined by the Department of Health Victoria. For more information, please visit their website: Persistent or chronic primary pain | src.health.vic.gov.au.

Please note that this document outlines the information that should be included in a referral request: https://www2.health.vic.gov.au/about/publications/researchandreports/Summary-and-referral-information

The Health Independence Program chronic pain service is a multidisciplinary service focused on exploring how to self-manage to live well with the presence of persistent or chronic pain. These referral criteria identify the patients most likely to benefit from this type of intensive service. A different service should be considered for patients who do not meet these referral criteria. Patients that only require procedures or medical interventions (e.g. nerve blocks) should be referred to an acute pain clinic.

Referral Forms and Instructions- Internal referrals 

External referrals

Clients need to meet all the following criteria for referral acceptance: –

• persistent or chronic pain (> 3 months duration) with symptoms that impact on daily activities including impact on work, study, school or carer role
• multiple presentations for exacerbations of pain despite adequate treatment in previous 12 months (exercise and analgesia)
• at risk of functional or psychological deterioration, or medication dependence
• willing to explore living well with pain and is willing to learn to self-manage ongoing pain

OR

The client:

• has suspected or acute complex regional pain syndrome (CRPS) where early specialist management is critical. Please ensure your referral contains as much relevant information as able to enable us to triage these cases with the highest priority.

For a referral to proceed, you must be able to answer ‘no’ to ALL the following:

The client:

• is undergoing active cancer treatment
• has an active compensable claim (e.g. TAC, WorkCover)
• is still undergoing diagnostic investigations or have current acute pain after recent surgery or other acute intervention.
• only requires medical interventional procedures (e.g. nerve blocks)
• is already involved with another pain clinic
• is in acute pain crisis and requires urgent care (physical, psychological or social)
• has already completed a comprehensive pain management program for the same pain condition
• We do not accept patients, with acute on chronic pain; solely for the purpose of supporting opiate weaning.

As per Department of Health Victoria SRC Guidelines, referrals may be rejected if our service is inappropriate for the patient, or if limited information is given in the referral. We will provide the reason in return correspondence. If you would like to discuss this further, please contact the clinic.

For further referral information contact the Community Access Unit

• Ph: 03 9881 1100
• Fax: 03 9881 1102
• Email: sacs.integratedcare@easternhealth.org.au

We do not offer a cure. You need to be willing to explore living well with pain and want to learn to self-manage ongoing pain. You will not be able to receive interventional procedures such as dry needling or injections.

We are not a prescribing service. Following medical assessment, the pain specialist may recommend changes to medication regime; to be followed up by GP/ primary care provider.  

We do not provide scripts or arrange for diagnostic or interventional treatment i.e. MRI, neuro-stimulation, nerve blocks, ketamine infusion, etc. We also cannot endorse medicinal cannabis for management of your pain.

We are not a referral pathway for clients presenting with acute pain conditions, or those requiring weaning plans post an acute stay. We do not accept clients requiring advice surrounding medications or for permit requirements only.

We do not provide long-term care. Engagement at the clinic is designed to be for short-term programs, working on specific goals and developing skills in self-management, and do not replace community-based services. We do not offer functional assessments for NDIS or DSP applications.

Clients are not eligible if they have already completed a multidisciplinary, comprehensive chronic pain management program or service for the same identifiable cause of pain and there are no other changes to your circumstances.

Compensable patients (this includes WorkCover and TAC), should be referred to a non-public healthcare service as a first option, should you feel they require our services- please phone the clinic to discuss.

We are not a crisis service, mental health service and do not offer functional assessments for NDIS or DSP applications.

Should you wish to discuss a referral and any eligibility criteria- please call the CPC Team Leader on 0409352074

Group-based services

Service Orientation Session: A face-to-face group education session providing up-to-date pain science and a brief overview of some pain management strategies. This session is compulsory to all clients in the clinic and clients are required to complete a pain questionnaire (Persistent Pain Outcome Collaboration (ePPOC)) to engage in further services.

Pain Assessment: a face-to-face interview with one of the pain clinicians to explore the contributing factors to the client’s pain condition, set realistic goals and establish a plan for care.

Attention Training Group: a 1-hour weekly online group-based session providing clients with the opportunity to develop flexible attention and mindfulness skills. Over six unique sessions we will train these skills through a mix of education, practical exercises and group discussions. These sessions are facilitated by a health psychologist.

Pain Management Program: a face-to-face group-based program facilitated by physiotherapy, health psychology and occupational therapy. This group runs for 3-hours, once a week for 8 weeks and includes supervised exercise, mindfulness and practical education sessions relevant to pain including sleep management, tai chi and graded exposure. The Pain Management Program is guided by Acceptance and Commitment Therapy principles. This program is run at Eastern Health Lulydale (Tuesdays) and Eastern Health Angliss (Fridays).

 1:1 Therapies

Health Psychology: Psychologists can work with clients to explore and understand the way in which pain interacts with important aspects of their life, including their ability to be productive, to have fun, to make healthy choices and to connect with others. Our psychologists are experts in the role that thoughts, feelings and behaviours play in the perception of pain and suffering and can teach a range of useful strategies and skills to benefit people with all pain conditions. Our clinic does not provide long-term or crisis mental health support as there are other services that are better able to assist.

Occupational Therapy: Our occupational therapists will work with the client to enhance their ability to engage in daily activities using a range of strategies including education, graded exposure, aids and equipment, task analysis and sensory integration. We are unable to offer functional assessments for NDIS or DSP applications.

Physiotherapy: Our physiotherapists will work with the client to learn more about their unique pain experience and how pain behaves. We focus on how pain affects day-to-day activities and its relationship with the body. We make steps towards recovery with education, exercise prescription and individualised recommendations for non-medication based self-management strategies. Within CPC, physiotherapy is limited to those interested in engaging in the Exercise Group (see above).  We cannot provide long-term involvement or passive modalities such as massage, dry needling and manual therapy.

Pharmacy: Our pharmacist can provide education and advice on medication use for the client’s pain condition including benefits, risks and the appropriate use of medicines to prevent medicine related harm.

 Medical

The CPC medical clinics offer pain assessment, consultation and advice to clients on how to best manage medications for persistent pain. We focus on reducing the risk associated with polypharmacy and high levels of opiates. The CPC medical clinics are not diagnostic and do not provide prescriptions, interventions (e.g. neuro-stimulators, nerve blocks or ketamine infusions) or endorse the use of cannabis.

Some clients may be seen in our Opiate Dependence and Pain Addictions Clinic (ODPAC). ODPAC is designed for a complex client population with physical dependence on prescribed and possibly non prescribed drugs being used for pain relief. This is done by liaising with the GP and providing expert assessment and recommendations. It also plays a vital role in implementing the Drugs and Poison Unit (DPU) practice guidelines pertaining to opiate prescription and supporting the use of opiate substituting drugs. The following criteria apply for clients to be seen in ODPAC:

• If OMEDD > 100mg
• 3 or more Schedule 4 and/or Schedule 8 drug
• Other illicit drug use (recent <3/12) including heroin and methamphetamine
• The client is willing to engage in reducing opioids

There is a cost for our service, which we will explain to you when we call to discuss your treatment plan.

We understand that covering the cost of health can be hard, even if you received the service in a public hospital. If you are worried that you may not be able to pay, please contact the Patient Accounts team to talk through your situation.

While waiting for an appointment, learn practical strategies for managing chronic pain, and associated low mood and anxiety with one of these online programs:

• This Way Up: https://thiswayup.org.au/programs/chronic-pain-program/
• Mindspot Clinic: https://mindspot.org.au/course/chronic-pain/

If you require mental health support, consider these options:

• Beyond Blue: 1300 224 636, https://www.beyondblue.org.au/get-support
• Head to Health: https://www.headtohealth.gov.au/
• Mental Health Treatment Plan: https://www.healthdirect.gov.au/mental-health-treatment-plan
• South Eastern Primary Health Network: https://www.semphn.org.au/access-and-referral
• Support Connect: https://supportconnect.org.au/
• Steps Mental Health: https://stepsmentalhealth.org.au/

Suicide and Crisis Support: If there’s an immediate risk of harm to yourself or others, please call 000 now. If you are feeling suicidal, or want to support someone who is, talk to a crisis counsellor now:

• Lifeline 13 11 14
• Suicide Call Back 1300 659 467

The Victorian Drug and Alcohol Advisory Service:

The Victorian Drug and Alcohol Advisory Service (DACAS) is a specialist telephone consultancy service that is free of charge for health and welfare professionals.

• Phone: 1800 812 804
• Website: https://www.dacas.org.au/

Schedule 8 permits:

A practitioner is not required to obtain a Schedule 8 permit to prescribe one (or more) of the following opioid analgesic formulations provided the combined daily dose of opioids does not exceed 100 milligrams in morphine equivalence.

• Website: https://www.health.vic.gov.au/drugs-and-poisons/schedule-8-permits-and-notifications