When should I refer a patient with chronic pain to a specialist for further evaluation or management?

Refer a patient with chronic pain to a specialist for further evaluation or management if:

• There are red flag signs or symptoms suggesting serious underlying pathology requiring urgent assessment.
• Non-specialist management is failing and the chronic pain is poorly controlled despite optimal treatment.
• The patient experiences significant distress related to their pain.
• A specific specialist intervention or assessment is needed, for example, if complex regional pain syndrome is suspected.
• In cases of neuropathic pain, referral to a specialist pain service or condition-specific service should be considered if the pain is severe, significantly limits lifestyle or daily activities (including sleep), or if the underlying health condition has deteriorated.

Additionally, consider referral if the diagnosis is uncertain and specialist input is needed to clarify the cause or guide management.