Ambulatory Pain Management Service

Welcome to the Eastern Health Ambulatory Pain Management Service. We are an interdisciplinary team of specialist health professionals offering short-term therapy for people living with persistent pain. We work together to explore the factors contributing to the client’s pain condition and provide education and advice around self-management strategies to improve their life. We focus on evidence-based assessment and treatment and offer a range of services delivered by physiotherapy, health psychology, occupational therapy, pharmacy and a medical team.

Service Orientation Session: A face to face group education session providing up-to-date pain science and a brief overview of some pain management strategies. This session is compulsory to all clients in the clinic and clients are required to complete a pain questionnaire (Persistent Pain Outcome Collaboration (ePPOC)) to engage in further services.

Pain Assessment: a face-to-face interview with one of the pain clinicians to explore the contributing factors to the client’s pain condition, set realistic goals and establish a plan for care.

Attention Training Group: a 1-hour weekly online group-based session providing clients with the opportunity to develop flexible attention and mindfulness skills. Over six unique sessions we will train these skills through a mix of education, practical exercises and group discussions. These sessions are facilitated by a health psychologist.

Exercise Group: a weekly face-to-face group-based session supervised by physiotherapy and an allied health assistant. The client is assessed by a physiotherapist and provided with an individual exercise program prior to engaging in the group. Over 8 sessions, the client will learn how to monitor their pain, modify exercises and develop a positive association with movement.

Pain Management Program: a face-to-face group-based program facilitated by physiotherapy, health psychology and occupational therapy. This group runs for 3-hours, once a week for 8 weeks and includes supervised exercise, mindfulness and practical education sessions relevant to pain including sleep management, tai chi and graded exposure. The Pain Management Program is guided by Acceptance and Commitment Therapy principles. This program is run at Yarra Ranges Health (Tuesdays) and Angliss Hospital (Fridays).

Health Psychology: Psychologists can work with clients to explore and understand the way in which pain interacts with important aspects of their life, including their ability to be productive, to have fun, to make healthy choices and to connect with others. Our psychologists are experts in the role that thoughts, feelings and behaviours play in the perception of pain and suffering, and can teach a range of useful strategies and skills to benefit people with all pain conditions. Our clinic does not provide long-term or crisis mental health support as there are other services that are better able to assist.

Occupational Therapy: Our occupational therapists will work with the client to enhance their ability to engage in daily activities using a range of strategies including education, graded exposure, aids and equipment, task analysis and sensory integration. We are unable to offer functional assessments for NDIS or DSP applications.

Physiotherapy: Our physiotherapists will work with the client to learn more about their unique pain experience and how pain behaves. We focus on how pain affects day-to-day activities and its relationship with the body. We make steps towards recovery with education, exercise prescription and individualised recommendations for non-medication based self-management strategies. Within APMS, physiotherapy is limited to those interested in engaging in the Exercise Group (see above).  We cannot provide long-term involvement or passive modalities such as massage, dry needling and manual therapy.

Pharmacy: Our pharmacist can provide education and advice on medication use for the client’s pain condition including benefits, risks and the appropriate use of medicines to prevent medicine related harm.

Medical team: The APMS medical clinics offer pain assessment, consultation and advice to clients on how to best manage medications for persistent pain. We focus on reducing the risk associated with polypharmacy and high levels of opiates. The APMS medical clinics are not diagnostic and do not provide prescriptions, interventions (e.g. neuro-stimulators, nerve blocks or ketamine infusions) or endorse the use of cannabis.

Some clients may be seen in our Opiate Dependence and Pain Addictions Clinic (ODPAC). ODPAC is designed for a complex client population with physical dependence on prescribed and possibly non prescribed drugs being used for pain relief. This is done by liaising with the GP and providing expert assessment and recommendations. It also plays a vital role in implementing the Drugs and Poison Unit (DPU) practice guidelines pertaining to opiate prescription and supporting the use of opiate substituting drugs. The following criteria apply for clients to be seen in ODPAC:

• If OMEDD > 100mg
• 3 or more Schedule 4 and/or Schedule 8 drug
• Other illicit drug use (recent <3/12) including heroin and methamphetamine
• The client is willing to engage in reducing opioids

APMS is part of the Health Independence Program and subject to Statewide Referral Criteria (SRC) for public specialist clinics as outlined by the Department of Health Victoria. For more information, please visit their website: https://src.health.vic.gov.au/specialities

Inclusion criteria:

For a referral to proceed you must be able to answer ‘yes’ to the following:

The client:

• has persistent pain (> 3 months duration) with symptoms that impact daily activities including work, study, school or a carer role.

AND

• has undergone an adequate trial of treatment in the previous 12 months (including but not limited to physiotherapy, exercise, appropriate medical investigations and trial of analgesia)

AND

• is willing to explore living well with pain and learn self-manage strategies

OR

The client:

• has suspected or acute complex regional pain syndrome (CRPS) where early specialist management is critical. Please ensure your referral contains as much relevant information as able to enable us to triage these cases with the highest priority.

OR

The client:

• has a high medication risk (polypharmacy, dependence, OMEDD > 100mg/day).

Exclusion criteria:

For a referral to proceed, you must be able to answer ‘no’ to ALL the following:

The client:

• is undergoing active cancer treatment
• has an active compensable claim (e.g. TAC, WorkCover)
• is still undergoing diagnostic investigations
• only requires medical interventional procedures (e.g. nerve blocks)
• is already involved with another pain clinic
• is in acute crisis and requires urgent care (physical, psychological or social)
• has already completed a comprehensive pain management program for the same pain condition

Referral information required:

Referral form and instructions: https://www.easternhealth.org.au/health-professionals/gp-referral-templates

As per Department of Health Victoria SRC Guidelines, referrals may be rejected if our service is inappropriate for the patient, or if limited information is given in the referral. We will provide the reason in return correspondence. If you would like to discuss this further, please contact the clinic.

For further referral information contact the Community Access Unit, Peter James Centre

• Ph: 03 9881 1100
• Fax: 03 9881 1102
• Email: [email protected]

Each session with the Ambulatory Pain Management Service costs $10 per session, and this is capped at $10 per day. In instances of financial hardship, this fee can be waived; please advise our team as early as possible. For further information, please contact Eastern Health Patient Revenue Services

While waiting for an appointment, learn practical strategies for managing chronic pain, and associated low mood and anxiety with one of these online programs:

• This Way Up: https://thiswayup.org.au/programs/chronic-pain-program/
• Mindspot Clinic: https://mindspot.org.au/course/chronic-pain/

If you require mental health support, consider these options:

• Beyond Blue: 1300 224 636, https://www.beyondblue.org.au/get-support
• Head to Health: https://www.headtohealth.gov.au/
• Mental Health Treatment Plan: https://www.healthdirect.gov.au/mental-health-treatment-plan
• South Eastern Primary Health Network: https://www.semphn.org.au/access-and-referral
• Support Connect: https://supportconnect.org.au/
• Steps Mental Health: https://stepsmentalhealth.org.au/

Suicide and Crisis Support: If there’s an immediate risk of harm to yourself or others, please call 000 now. If you are feeling suicidal, or want to support someone who is, talk to a crisis counsellor now:

• Lifeline 13 11 14
• Suicide Call Back 1300 659 467

The Victorian Drug and Alcohol Advisory Service:

The Victorian Drug and Alcohol Advisory Service (DACAS) is a specialist telephone consultancy service that is free of charge for health and welfare professionals.

• Phone: 1800 812 804
• Website: https://www.dacas.org.au/

Schedule 8 permits:

A practitioner is not required to obtain a Schedule 8 permit to prescribe one (or more) of the following opioid analgesic formulations provided the combined daily dose of opioids does not exceed 100 milligrams in morphine equivalence.

• Website: https://www.health.vic.gov.au/drugs-and-poisons/schedule-8-permits-and-notifications