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Chronic pain

What is persistent pain?

Sometimes pain continues longer than expected and does not respond to conventional approaches. When the pain system becomes stuck in a high state of alert, it can have significant impact on many areas of life and be difficult to manage. Our service works with people to try and help improve the situation.

We are a team of different professionals including consultants, associate consultants, specialist nurses, clinical psychologists, specialist physiotherapists and pharmacists. There are two aspects to the service a medical and a biopsychosocial arm, who work together using the most up to date guidelines and evidence to help the person living with ongoing pain improve quality of life and function.

What happens when you are referred?

Your referral will be triaged to the part of the service which is most likely to be helpful for you. A letter will be sent to you explaining this and asking you to confirm that you want to be seen.

Once you reach the top of the waiting list you will be offered an appointment which may be via telephone, video or face to face. There will be an assessment and plan agreed on the basis of this and all the other information available. A letter will then be sent to yourself and the referrer / your GP summarising this.

Who can refer?

Any health professional within the health board (or in some cases outside the health board), who has identified that you have a persistent pain problem which requires more specialist input. They should have ensured that you have been appropriately investigated (including all “Red Flags”) and that treatment and initial management options have been explored with limited benefit.

Some resources you may find helpful

There is a lot of helpful information available to guide people living with persistent pain. Here are some reliable sources of information and advice which may include things that you could try whilst you are waiting to be seen.


Referral Information

Important Information:
Prior to making a referral, please be aware of current guidelines (Living with Persistent Pain in Wales (WG 2019/2023, NICE NG193, NG 59, CG173, CG150) which are very specific about which interventions may be offered and the indications for these.  (For example, do not offer injections for non-specific low back pain). Discussing specific interventions with people who may not meet the criteria, may not assist them in fully engaging with approaches that are likely to be more helpful and sustainable.
If a person’s behaviour and ability to engage with a self-management process is significantly compromised (eg severe or unmanaged psychotic symptoms, problematic substance misuse, severe cognitive impairment), please inform us of the specific issues. This will allow us to identify whether we are the best service to assist with their care or whether this is better done through another service with our support. People who are actively suicidal / high risk should be referred to the Crisis Team initially.

Pre-Referral requirements:

Please ensure the following have been attempted in the prior to referral:

  • Appropriate medication management has been explored and optimised in line with guidelines. EG Neuropathic Pain Guidelines (Appendix 3)
  • Appropriate investigations into treatable pathology have been completed and any indicated onward referral to other services has been done.
  • The person has been directed to and shown some engagement with appropriate self-management options such as Versus Arthritis, EPP and virtual resources such Pain Tool Kit and Flippin Pain. 
  • There has been appropriate discussion about the nature and management of persistent pain in line with the Living Well with Persistent Pain guidance (WG 2019, updating 2023).

Failure to demonstrate this in the referral letter will result in the referral being declined and returned

Referral Criteria


  • Post-surgical pain not managed with protocol/appropriate strategies/Acute pain team involvement, less than 3 months post-surgery.
  • Trigeminal neuralgia with difficulty eating or drinking – In most instances these referrals are forwarded to Cardiff and Vale UHB for specialist treatment. This can be done from paper triage by the pain team if sufficient information is provided by the referrer.
  • Chronic Regional Pain Syndrome (CRPS) of less than 6 months onset which meets the Budapest criteria for diagnosis.
  • Severe unresolving post herpatic neuralgia that has not responded to anti-viral medication, with symptoms for more than 12 weeks.
  • Ischemic pain not amenable to surgery (as identified by a Vascular Consultant).


  • Pain is considered to be persistent, if it is not improving with appropriate management after a period of 3 months (if pre-referral criteria is met)
  • Persistent pain failing to respond to primary care or other management as outlined above in the pre-referral criteria
  • There is evidence of “yellow flags” after primary care management outlined above has been exhausted. (As identified from Keel BaCK Tool or Information provided). (See Appendix 1)
  • Trigeminal neuralgia without significant impact on eating and drinking.

Exclusion criteria:

  • Red flag symptoms that have not been investigated. (See Appendix 2)
  • People with vascular pain (Please refer to vascular surgeon).
  • The pain service will only accept referrals for patients under the age of 18 from Paediatric services or after discussion and agreement to assess.
  • Please note that the Biopsychosocial service only accepts Adults (over 18’s), but may be able to work jointly with Paediatric services or the medical pain management service as appropriate.
  • The person is currently waiting to see or waiting for definitive treatment with another speciality for the same condition (e.g., Rheumatology, Orthopaedics, CMATS, Gastroenterology)
  • ME/Chronic Fatigue without pain (Please refer to Post-Viral and Fatigue management service, if indicated)
  • Cancer pain is managed by a separate pathway – referrals would only be accepted in line with these specific agreements.
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