For Health Professionals

Criteria for entry to public persistent pain services is established by the Victorian Department of Health. To be considered for services the patient MUST meet ALL of the following:  

• persistent or chronic pain (longer than 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 the 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 

Note: Please indicate if your patient is presenting with symptoms suggestive of STAGE 1 Complex Regional Pain Syndrome. A more urgent assessment may be possible. 

A referral to the service is NOT appropriate if the client: 

• is less than 18 years of age (refer to VPRS or Royal Children’s Hospital) 
• is not willing to explore living well with pain and/or open to learning to self-manage ongoing pain 
• is already referred to another pain service for the assessment, or treatment of, the identifiable cause of pain 
• is currently undertaking another chronic pain management program 
• has already completed a multidisciplinary, comprehensive chronic pain management program or service for the same identifiable cause of pain where their clinical symptoms, or their readiness to undertake a chronic pain management program, remain unchanged 
• wants physical intervention ONLY such as an injection or dry needling 
• wants to receive services as a compensable patient 
• is currently involved in active litigation (for any reason) 
• is actively experiencing dependence/tolerance/withdrawal from ANY medications and/or other substances (refer to addiction medicine as first step towards pain management) 
• is experiencing severe and/or untreated/poorly managed mental health concerns 
• is cognitively compromised (for any reason) 

Other factors may also impact a client’s ability to benefit from and/or participate in programs which will be determined at the point of intake. 

Any clients presenting with the following symptoms should be directed to the Emergency Department: 

• rapidly progressive neurological symptoms leading to weakness or imbalance 
• suspected cauda equina syndrome (e.g. leg weakness, loss of bowel or bladder control) 
• Central nervous system, autonomic and neuromuscular symptoms suggestive of serotonin syndrome 
• symptoms of respiratory depression, unconsciousness and pupillary miosis suggestive of opioid toxicity

Allied health persistent pain health improvement programs take a holistic approach to supporting people to rehabilitate from and/or manage/cope with non-cancer related persistent pain. The programs aim to reduce the impact of persisting pain by providing evidence-based education and promoting active approaches to improve function, physical/mental health and quality of life. 

Patients seeking physical/medical intervention ONLY may be encouraged to seek alternative services. 

Programs are offered at two main sites: 

• Ballarat 
• Horsham  

Programs may include: 

• an intake interview 
• multi-disciplinary group pain education  
• multi-disciplinary group intervention programs 
• assessment and treatment planning 
• links to time-limited individual allied health-based interventions 

Programs may be delivered through face to face, telephone and/or telehealth. 

Programs may also assist with recommendations to other services (i.e. local and/or online) but DO NOT offer case management.  

Access and referrals 

• MUST meet statewide referral eligibility criteria 
  • pain >3 months impacting daily function 
  • frequent ED visits despite treatment 
  • risk of psychological decline or med dependence 
  • willingness to explore self-management 
• DO NOT see cancer related pain (refer oncology) 
• Referrals welcome from ALL health professionals (internal and external) 
• Self-referrals are welcome but must be directed to service coordinator/leader of the program 
• Send referrals to the nearest program location to patient’s residence (see contact details below) 

Note: Please ensure that the patient is aware and consenting of the referral made. 

INTERNAL referrals 

Required documents: 

• Form MR023.0 – ALLIED HEALTH OUTPATIENT  
  • Tick box PROGRAM - PERSISTENT PAIN MANAGEMENT  

Contact  

Ballarat 

Peter Heinz Centre (QEC)
102 Ascot Street, Ballarat 

• Phone: 03 5320 3700  
• Fax: 03 5320 3800 
  • Referrals
    • INTERNAL and EXTERNAL to Central Intake 
    • Phone: 03 5320 6690
    • Fax: 03 5320 3893
    • Email: CentralIntakeReferrals@gh.org.au      

Horsham 

Arapiles Building
83 Baillie Street, Horsham 

• Phone: 03 5381 9333  
• Fax: 03 5381 9330
  • Referrals
    • EXTERNAL in writing to Intake
    • Phone: 03 5381 9115
    • Fax: 03 5381 9330
    • Email: Intake.Worker@gh.org.au 
    • INTERNAL via RIMS 

Stawell

Please direct referrals to Horsham

EXTERNAL referrals 

Submitted in writing and MUST include the following: 

• pain history: onset, location, nature of pain and duration 
• psychological status and cognitive function 
• details of previous pain management including the course of treatment(s) and outcome of treatment(s) 
• comprehensive past medical history 
• history of alcohol, recreational or injectable drugs, or prescription medicine misuse 
• current and complete medication history (including non-prescription medicines, herbs and supplements)

Provide if available: 

• details of functional impairment 
• psychiatric history 
• details of any current behaviours that may impact on the person’s ability to participate in a chronic pain management program (e.g. behaviours of concern, level of alcohol intake, cognition issues, reliance on a carer, mental health issues) 
• if the person has been identified as having high-risk circumstances (multiple provider episodes, high-risk drug combinations, or opioid dose threshold) through SafeScript 
• results of previous investigations 
• if the person has previously completed a chronic pain management program and if so the provider of the program 
• if a medication review or assessment is required 
• if the person is part of a vulnerable population