Pain

Referral will be accepted if the person meets the following criteria

Persistent pain for at least 3 months
Pain is significantly affecting the ability to engage with usual daily activities
Relevant health conditions identified and treated
The following blood tests results are normal, or abnormalities have been fully treated (please detail in referral letter):
- - - C-reactive protein.
    - Full blood count.
    - Thyroid function test.

Consider extra tests on a case-by-case basis (please fully investigate and treat any abnormalities before referral)

- Vitamin D and bone profile (if widespread bone/joint tenderness/ache)
- Creatine Kinase (if muscle tenderness)
- Imaging is not routinely needed. Please send us a copy of any relevant imaging that has been done.
- Consider menopause as a cause or contributing factor in relevant people

Additional referral guidelines:

Please note PLWS is not a diagnostic service.
We ask referrers
- to examine, investigate and refer to other specialties as appropriate,
- to exclude the following red flag symptoms:
  - Those that may suggest cancer — such as fever, sweats, chills, unexplained weight loss, older age and new onset of symptoms, history of cancer, persistent, non-mechanical bone pain, and/or pain that worsens at night or when supine.
  - Those that may suggest, or increase the risk of, infection — such as fever, sweats, chills, immunosuppression, and/or history of IV drug use.
  - Neurological features in people with lower back pain suggestive of cauda equina syndrome.
- to check for drug-based causes of widespread persistent pain (opioid hyperalgesia, aromatase inhibitors and lipid lowering medication)
- Consider and treat if appropriate, menopausal causes of widespread body pain

Resources for referrers

Please see the following evidence-based advice on how to assess chronic pain (both primary and secondary pain),

This NICE resource has guidance on signs and symptoms (red flags) of serious conditions that may cause persistent pain

Fibromyalgia diagnosis in primary care: These resources are very helpful from the Royal college of physicians