A chronic pain patient may need to be referred to a pain specialist if certain conditions are met.

Indications for referral to a pain specialist:

(1) outcome failure after 6 weeks of treatment (failure to control pain after 6 weeks)

(2) ongoing adverse effects from optimized therapy

(3) unexpectedly large doses of opioids required

(4) frequent use of breakthrough dosing (more than a few times per month)

(5) opioid-induced hyperalgesia

(6) opioid overdose

(7) need for conversion to sublingual buprenorphine AND unable to use transdermal or buccal buprenorphine (due to high opioid doses or if insurance denial)

(8) complex discontinuation of an opioid

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