Explore our clinician-focused articles on persistent and complex pain, clinical reasoning and interventional treatments.
Not every referral needs to come with a diagnosis or proposed treatment. I welcome referrals for patients with persistent or complex pain where a specialist pain medicine opinion may help clarify the clinical picture or identify a way forward.
Persistent pain despite appropriate investigation and treatment
Widespread or multiple pain problems
Pain following surgery, injury or illness
Neuropathic pain
Persistent spinal or musculoskeletal pain
Symptoms difficult to reconcile with imaging or investigations
Diagnostic uncertainty
Complex treatment histories
The aim is not necessarily to find a single intervention or medication. Sometimes the most useful outcome is a clearer understanding of the factors contributing to the patient’s pain and a practical plan for managing it. Recommendations may include medical treatment, physical rehabilitation, psychological approaches, self-management strategies or an intervention where appropriate.
We welcome referrals from colleagues for assessment and consideration of a specific pain intervention.
Lumbar medial branch blocks
Radiofrequency denervation
Caudal epidural injections
Transforaminal epidural/ selective nerve root injections
Sacroiliac joint injections
Suprascapular nerve blocks
Intercostal nerve blocks
Trigger point injections
Occipital nerve blocks
Selected peripheral and diagnostic nerve blocks
If you are unsure whether a particular intervention may be appropriate, I am very happy to review the patient and advise. All patients are assessed before proceeding with an intervention. This provides an opportunity to review the clinical indication, relevant imaging and previous treatment, and to discuss the potential benefits, limitations, alternatives and risks with the patient. Where an intervention is not appropriate, I will explain this to the patient and suggest alternative approaches where possible.
What to include with your referral
A brief clinical letter is usually sufficient.
Supporting information may include:
The presenting problem and working diagnosis
Relevant previous treatments and their outcome
Relevant imaging or investigation reports
Significant medical history and current medication
The intervention you would like considered, if applicable
Any particular clinical question you would like me to address
Please don’t delay a referral because all of this information isn’t immediately available. Further information can be obtained where necessary.
What happens after referral?
I will assess the patient and discuss the available options with them.
Following the consultation, I will write to you summarising my assessment and recommendations.
If an intervention is appropriate, this can be arranged at Nuffield Health Hereford Hospital.
Following treatment, I will provide details of the procedure undertaken and the subsequent plan.
Where appropriate, patients can then return to your care, with further review available if required.
Referrals can be made directly to Wye Sanctuary. If you are uncertain whether a referral is appropriate, or would like to discuss whether I can offer a particular intervention, please feel free to contact the clinic.