When NOT to refer
- When there is active substance abuse. Chronic pain cannot safely or effectively be treated though an outpatient pain medicine clinic when the patient has an active substance use disorder. This patient should be referred for substance abuse treatment, then perhaps for outpatient pain medicine evaluation. Please call us for assistance finding the right resources, we are happy to do phone consults.
- When there are severe psychosocial issues (homeless and disorganized, out of control family/social situation, for example) and/or active severe mental health co-morbid factors make it unlikely that a therapeutic relationship can be maintained through an outpatient clinic. Please call us for assistance finding the right resources, we are happy to do phone consults.
- When pain medications have just been stopped and there is no plan for what to do next. Patients sometimes come in for a consult asking “but what am I going to do, my doctor will not prescribe my pain medication?” The patient is focused on the medication issue and frustrated with us when we explain that we cannot address medication issues until we have done a complete work up – which can take a few visits. These sorts of visits are usually unhelpful for everyone, patients often do not return. Yet we understand that not prescribing pain medicine is sometimes the right thing to do for the patient, so please call us for a phone consult when you want to stop medication but also want specialist help.