Acute lumbar spinal pain with radicular leg pain, Patients with acute sciatica can usually be assessed and treated within a week, including imaging such as MRI and injection of epidural corticosteroid where indicated.

Acute and chronic lumbar spinal pain with/without radicular leg pain (back pain and sciatica), Acute and chronic cervical (neck) spinal pain with/without radicular arm pain, Neuropathic pain e.g. post herpetic neuralgia; nerve compression syndromes e.g. carpal tunnel syndrome, nerve injury pain, Complex Regional Pain Syndrome, Phantom limb pain, Post surgery pain syndromes, Most often, the focus of the consultation is on the diagnosis and explanation of the condition, and a full discussion of the treatments available, including medication and interventional options. An interdisciplinary management approach is preferred, and the patient and their GP are considered central to the long term management.

We would discuss and explain the risks of the various pharmacological analgesic options, including adjuvant/co-analgesics and opioids and their combination. Trials of the medication options can be offered and would require sequential visits and appropriate monitoring. It is expected that the long term supervision of all medication, including opioids, would be undertaken by the patient's GP.

Office based: trigger/tender point needling or injection tendon enthesis or sheath injection of local anaesthetic and corticosteroid or autologous blood intra-articular or peri-articular injection of local anaesthetic corticosteroid., Outpatient procedures including: spinal injections under fluoroscopy e.g. inter-laminar epidural transforaminal zygapophysial/facet or sacro-iliac joint injection diagnostic and/or therapeutic nerve blocks and medication infusions., Complex procedures such as radiofrequency neurotomy for neck and back pain of zygapophysial origin.

Orthopaedic surgeons where there is a need to consider or exclude a specific treatment option., Psychiatrist or psychologists for assessment and support for patients who have co-existing mood or other psychological disturbance in association with their pain. This sort of support can be useful for some patients where there is no clear line of surgical, interventional or pharmacological treatment, or where these have failed., Physiotherapists, either on or offsite, for physical based therapies such as graded motor imagery or rehabilitative exercise and rehabilitative programmes., Other specialists where clinically indicated., A tertiary service, particularly for paediatric patients or adults with complex pain disorders and/or where treatment in the community seems impractical., While an interdisciplinary approach is preferred, this is not always entirely possible in practice, largely because of vagaries related to funding and third party insurers.