Pain Medicine Unit

The Pain Medicine Unit provides multidisciplinary assessment and treatment for people with persistent non-cancer and cancer pain. Our team includes:

  • pain medicine doctors
  • psychiatrists and clinical psychologists
  • nursing staff
  • physiotherapy and occupational therapy staff
  • clerical staff.

We offer both on-site consultations and video and phone consultations, including referrals to local services as appropriate. Regional patients are offered video and phone consultations and alternative ways of receiving pain management education.

Accessing our services

Your general practitioner (GP), private specialist, hospital doctors or allied health professionals can refer you to our service.

This referral, and your responses to a questionnaire we send you, helps us assess your pain and its impact on your life.

It is very important that you return the completed questionnaire to us to activate your referral and enable us to plan a pain management pathway for you.

You may be asked to complete the questionnaire again during and after your treatment so we can measure improvements in your pain recovery.

Treatments

You will be offered an individual treatment plan that you can follow with the help of your GP and local health care professionals. This plan includes:

  • individual and group approaches to treatment
  • advice on non-opioid medication options
  • advice on ongoing medication use, to reduce risks.

Short Group Pain Management Program

After we receive your referral and completed questionnaire, most patients are given an appointment to attend our short group pain management program, also known as STEPS (Self-Training Educative Pain Sessions).

This program aims to provide you with up-to-date information and advice about the most effective management strategies for persistent pain, including:

  • understanding persistent pain
  • the use of medication and procedures
  • movement, exercise and daily activity options
  • psychological approaches to pain management
  • strategies to enable you to talk more effectively with your GP.

Individual assessment and treatment sessions

Once you have completed the STEPS program, you can request individual appointments with the doctor and/or other members of the multidisciplinary team to help you develop a personalised pain management plan.

Members of this team include:

  • pain specialist doctor
  • physiotherapist
  • clinical psychologist
  • occupational therapist
  • psychiatrist
  • clinical nurse specialist.

Long Group Pain Management Program

Following completion of the STEPS program, you may wish to be considered for our longer (5 weeks, 3 mornings a week), more intensive, interdisciplinary group program, known as Pain Understanding and Management Program (PUMP).

We recognise the complex nature of persistent pain and this program aims to help you re-engage in life. The treatment focuses on addressing you as a whole person, including:

  • using pacing to increase physical activity
  • stretches and strengthening exercises for pain
  • managing pain and distress through mindfulness
  • cognitive strategies and other techniques
  • sleep management.
Important information about opioids

Opioids include natural opiates (such as opium from poppies) and man-made compounds that act at the same receptors as natural opiates.

Opioid-based medicines may be used to reduce pain. They can reduce acute pain by 50 per cent for one person out of three, however are less likely to help chronic (persistent) pain.

There are two types of prescribed opioids: atypical and older opioids.

Atypical opioids

If we support the use of opioids for pain management, we mainly prescribe atypical opioids such as Tramadol, Tapentadol, and Buprenorphine, as the risks are lower than with older opioids.

Older opioids

Due to medium and long-term harms, we do not endorse nor prescribe harmful, older opioids including:

  • oxycodone products (Oxynorm, Oxycontin, Targin, Proladone)
  • hydromorphone
  • methadone
  • morphine
  • codeine
  • fentanyl.

These harms include:

  • increased pain as a result of taking opioid medications (known as opioid induced hyperalgesia)
  • reduced hormones levels like sex hormones (leading to osteoporosis) and lowering a range of other hormones.
  • suppression of the immune system (increasing risk of infection and cancer)
  • overdose causing sedation and coma
  • death.

We can assist in reducing the use of older opioids and switching to atypical opioids. We suggest self-referral to the NextSTEP Drug and Alcohol Service when the dose of older opioids exceeds 90 mg morphine equivalents, e.g. Oxycodone > 60 mg/day, hydromorphone > 18 mg/day.

We do not support the use of opioids and benzodiazepines at the same time as they can lead to involuntary overdose and death through:

  • respiratory depression
  • cognitive impairment with memory loss.

There is poor evidence that benzodiazepines improve muscle spasm. Less harmful alternatives for muscle spasms include magnesium, Orphenadrine, Baclofen and Dantrolene.

Ongoing opioid use beyond 12 months

Since June 2020 the Australian Government requires your prescribing doctor to ask you to see another doctor to seek support (in writing) for the ongoing prescription of opioids.

Any doctor registered in Australia may conduct this review for the Australian Government.

It is not mandatory to consult a pain specialist as part of the secondary review requirement for the Australian Government.

The Medicines and Poisons Regulation Branch of the Western Australian Department of Health may occasionally request a specialist pain medicine physician review, and your doctor should include the letter in the referral. This usually indicates you are on high dose opioids. The Fiona Stanley Hospital Pain Medicine team will request your GP to start reducing your opioid medication to minimise the harmful effects of opioids while you wait for your appointment with the pain specialist.

These changes prompt doctors to consider whether prescribing opioids are likely to give you greater benefits than the potential risks, or whether there may be other treatment options for you. This is due to multiple studies showing a lack of effectiveness with the use of long-term opioids for managing persistent non-cancer pain, and harms, especially at high opioid doses. For more information see https://www.tga.gov.au/prescription-opioids-information-consumers-patients-and-carers

Contact us

Phone the Pain Medicine Unit on 6152 7480 from 9am–3pm, Monday to Friday