Table 2.

Stage 1 and 2 – refinements made to the care pathway

Issue identified	Changes made to address this issue
Patients need to be identified earlier to ensure that treatment is initiated at 3 months post-operation.	Screening of patients to identify those with pain brought forward to 2 months post-operation to allow patients to be seen promptly at 3 months post-operation. A second screening process will occur prior to the assessment appointment to ensure that patients still have pain.
Patients who are offered nurse-led or self-monitoring need to be regularly followed up and referred to other services if needed.	‘Monitoring ‘changed to ‘follow-up’. Patients will be offered regular telephone follow-up with a health professional and further referrals if pain does not improve.
Physiotherapy should be a treatment option.	Physiotherapy included as a referral pathway.
There are additional ‘red flags’ that should initiate an urgent referral to a surgeon.	Knee stiffness or patellofemoral joint problems will initiate an urgent referral to an orthopaedic surgeon.
Patients with anxiety should be referred to their General Practitioner.	Signs of anxiety will initiate a General Practitioner referral for review and treatment.
Treatment of neuropathic pain should begin as soon as possible after assessment, ideally while waiting for pain clinic appointment.	Patients with signs of neuropathic pain will be referred to their General Practitioner to initiate medication treatment. If there is no improvement in 6 weeks, patients will be referred to a pain specialist.
Referrals to pain services needs to be via General Practitioner.	General Practitioners will be asked to request an urgent referral to pain services for patients who meet the diagnostic criteria for complex regional pain syndrome.