ACC7984 Pain Management Services Triage Report

**ACC7984** **Pain Management Services Triage Report** "Please complete this form to let us know about this client's triage assessment, the conclusions regarding the likely diagnosis/es and cause/s and the proposed clinical care pathway." "When you've finished, please send a copy to the ACC recovery team member managing the Claim or to claims@acc.co.nz if you are unsure of the Recovery Team Member/Recovery Team." **1. Client details** Client name: John Smith Address: 1 Example Street, Christchurch Claim number: ACC000-TESTCLAIM-05 Date of birth: 12/05/1975 **2. Vendor details** Supplier name: Baker Street Pain Management Service Vendor number: TEST-VEND-01 Phone number: 03 555 0410 Vendor email address: info@bakerstreetpain.co.nz **3. Confirmation of suitability for the Pain Management Service** **Recommendation:** [ ] Not suitable for a Pain Management service (see below) [ ] Group Programme [ ] Community Services Level 1 [x] Community Services Level 2 [ ] Tertiary Delivery Services "For clients who are recommended for the Pain Management Service, do they meet the eligibility criteria?" [ ] Not applicable, the Pain Management Service is not recommended [x] Yes, the client meets the eligibility criteria for the recommended Pain Management Service level [ ] No, please provide clinical rationale as to why the Client would benefit from a Pain Management service despite not meeting the eligibility requirements **4. Triage report** Description of the client's history **Injury history** John sustained a lower back injury in early 2025 after a fall from a ladder at work, resulting in a soft tissue injury to the lumbar spine. **Pain history** John reported persistent lower back pain since the injury, now approximately 18 months in duration, described as a dull, aching pain that becomes sharp with bending or prolonged sitting. The pain has spread intermittently into his left buttock and thigh over the past six months. **Previous persistent pain** John reported no significant persistent pain prior to this injury. **Mental health history** John reported no formal prior mental health diagnosis, though he described increasing worry and low mood since his pain became persistent. **Substance use** John reported drinking alcohol socially, a few standard drinks on weekends, and denied any illicit substance use. **Underlying conditions** None reported. **Current treatments** John is currently taking tramadol and paracetamol prescribed by his GP, and has previously seen a physiotherapist for a course of manual therapy and exercise. **Work and functional status** John has been on modified duties since the injury, working reduced hours in an office-based role, and reported difficulty sitting for long periods. Summary of Findings Taha Tinana — Physical Wellbeing: John presents with persistent lower back pain of 18 months' duration following a fall from a ladder at work, now with intermittent spread into the left buttock and thigh. His pain is aggravated by bending and prolonged sitting and eased somewhat by movement and changes in position. He retains reasonable overall mobility and has no red flag features reported. His current medication regimen includes tramadol and paracetamol, and the ongoing opioid use alongside 18 months of persistence suggests a relationship between the covered injury and his current presentation that is becoming increasingly complex rather than a simple, resolving soft tissue injury. Taha Hinengaro — Mental and Emotional Wellbeing: John has engaged well with his GP and physiotherapist to date, reflecting reasonable insight and a willingness to seek help. However, he described increasing worry about his pain not resolving and some low mood related to the impact on his work and daily activities. His pattern of thinking about the pain, particularly ruminating on whether it will ever improve, appears to be amplifying his distress and is likely contributing to his reduced confidence in managing tasks independently. Taha Wairua — Spiritual Wellbeing: John's sense of purpose has been disrupted by his reduced work capacity, as he has taken pride in being a reliable, hands-on employee. He retains a clear motivation to return to his previous level of functioning and describes his recovery as something he is committed to working towards, which is a positive prognostic sign. Taha Whānau — Family and Social Wellbeing: John reported living with his partner, who has been supportive through his recovery, and maintains contact with close friends, though he has reduced his usual weekend activities due to pain. His workplace has accommodated modified duties, which appears to be supporting rather than undermining his engagement with recovery. Whenua — Cultural Identity and Grounding: Cultural background and any specific cultural or spiritual considerations were not discussed during this triage assessment. Cultural safety planning is pending and should be explored further at intake. Overall, John's presentation reflects a persistent pain condition where physical, psychological, and functional factors are becoming increasingly interlinked, with rumination and reduced self-efficacy beginning to compound the physical picture. Without intervention, the risk is of further deconditioning and functional decline; with a structured community-level pain management programme addressing both the physical and psychological contributors, a good recovery trajectory is anticipated. Community Services Level 2 is recommended, with an estimated programme timeframe of 8–12 weeks. List of medicines | Medication | Dose | Frequency | Prescribing Clinician | Notes | |---|---|---|---|---| | Tramadol | 50mg | Twice daily | GP | OPIOID — monitor for ongoing dependence risk given 18-month duration | | Paracetamol | 1g | Four times daily | GP | | Summary of ePPOC results BPI: Pain severity composite 6/10, interference composite 7/10. These scores suggest moderate-to-severe pain that is meaningfully limiting John's daily activities, particularly prolonged sitting, mobility, and work capacity. DASS-21: Depression — Mild; Anxiety — Moderate; Stress — Moderate. Anxiety is the most elevated domain, consistent with John's reported worry about his pain not resolving. This distress appears to be interacting with his pain experience, likely amplifying his perception of pain severity and reducing his tolerance for activity. PCS: Total score 28, with Rumination as the dominant subscale. This pattern indicates John spends considerable time preoccupied with thoughts about his pain, which may reduce his engagement with active coping strategies and could affect his initial engagement with a pain management programme unless directly addressed. PSEQ: Total score 22/60. This relatively low score suggests significant self-limiting behaviour and low confidence in his ability to function despite pain, indicating a need for a programme with a strong self-management and confidence-building component. Opioid flag: John is currently prescribed tramadol, an opioid, for a duration of approximately 18 months. This carries an ongoing dependence risk and should be actively monitored throughout the pain management programme, with consideration given to a structured tapering plan where clinically appropriate. Date of Triage: 15/09/2026 Date of IDT Review: 22/09/2026 | Role | Name | Discipline | |------|------|------------| | Triage Clinician | Dr John Watson | Medical | | IDT Member | Dr Jennifer Melfi | Psychology | **5. Declaration and signatures** "I certify that: - I have personally examined and/or treated the client. - I have discussed the recommendations I have made in this report and the rationale for these with the client and other provider/s who have performed the triage and case review. - The client (or their representative) has authorised me to provide this information to ACC." Name of Triage clinician: Dr John Watson **Signature:** **Date:** 22/09/2026 "When we collect, use and store information, we comply with the Privacy Act 2020 and the Health Information Privacy Code 2020. For further details see ACC's privacy policy, available at [www.acc.co.nz](https://www.acc.co.nz). We use the information collected on this form to fulfil the requirements of the Accident Compensation Act 2001." **Items for Clinician Review** [ ] Section 4 – Pain history: the spread into the "left buttock and thigh" was described as occurring "intermittently... over the past six months" without more precise timing; confirm if a clearer timeline is available. [ ] Section 4 – Summary of ePPOC results: all scores (BPI, DASS-21, PCS, PSEQ) were reconstructed for this fictional example rather than transcribed from an actual completed measure; verify against the client's real completed questionnaires before relying on this section in practice. [ ] Section 4 – Opioid flag: tramadol dose and frequency (50mg twice daily) were stated once without confirmation of any recent dose changes; verify current dose against the GP's most recent prescription. [ ] Whenua – Cultural Identity and Grounding: no cultural information was available at triage; this has been explicitly flagged as pending rather than left blank, per the section's own instruction, but should be revisited at intake.