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: Hemi Walker Address: 47 Tāwā Road, Glen Eden, Auckland 0602 Claim number: 10068472 Date of birth: 22/06/1979 **2. Vendor details** Supplier name: Tāmaki Pain Service Vendor number: PMC8847 Phone number: 09 631 4422 Vendor email address: triage@tamakipain.co.nz **3. Confirmation of suitability for the Pain Management Service** **Recommendation:** Note: Choose Group Programme when required, and/or one of the following Community Level 1, Community Level 2 or Tertiary if required Rationale for any recommended Pain Management Service is provided in the Summary of Findings in Section 4. [ ] Not suitable for a Pain Management service (see below) [ ] Group Programme [ ] Community Services Level 1 [x] Community Services Level 2 [ ] Tertiary Delivery Services If the client is not suitable for the Pain Management Service, please explain why and any recommendations on what support or alternative service the client needs: 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 Include information on previous persistent pain, mental health conditions, substance misuse and any underlying conditions **Injury history** Hemi was injured on 14/10/2024 when his stationary taxi was struck from behind at traffic lights by a vehicle travelling approximately 40 km/h. He experienced immediate right-sided neck pain and right scapular pain, with delayed onset of intermittent right upper limb paraesthesia over the following 48 hours. The body region affected is the right cervical spine, upper trapezius, scapular region, and right upper limb. No loss of consciousness; no head strike. ACC-covered claim accepted for cervical whiplash. **Pain history** Pain duration is 19 months. Onset was acute and mechanical, initially well localised to the right paracervical and upper trapezius regions. Over the first 6 months the pain remained predominantly nociceptive in character. From approximately month 7 the pain progressively centralised, with widening of the affected area to involve the right interscapular region and intermittent radiation into the right forearm and hand. Current quality is aching with episodic sharp exacerbations and burning paraesthesia. Triggers include sustained driving, right cervical rotation, computer use, and lifting above 5 kg. Relieving factors include lying supine, heat, and tramadol. **Previous persistent pain** No prior history of persistent pain. Hemi reports an uncomplicated recovery from a left ankle fracture in 2011 (work-related, ACC) with no residual symptoms. **Mental health history** No formally diagnosed mental health conditions. Hemi describes a period of low mood approximately 8 years ago following the death of his father, managed within whānau without clinical intervention. He has no history of self-harm, suicidal ideation, or psychiatric admission. He has not previously engaged with psychological services. **Substance use** Alcohol use is social and within recommended limits, approximately 4 to 6 standard drinks per week. No illicit substance use. Tramadol is used as prescribed (see medication list); Hemi reports no escalation in self-administered dosing and is accepting of a structured taper as part of programme participation. Tobacco never used. **Underlying conditions** Type 2 diabetes (well controlled on metformin, HbA1c 52 mmol/mol at most recent reading 04/2026). Mild obstructive sleep apnoea (diagnosed 2023, declined CPAP). No inflammatory conditions. Clinical features consistent with central sensitisation are present and described in detail in the Summary of Findings below. **Current treatments** GP management with Dr Sue Patterson at Glen Eden Medical (regular reviews every 6 weeks). Community physiotherapy completed 12 weeks of treatment from 11/2024 to 02/2025 with limited functional gain; discharged. Two private sessions with a chiropractor 06/2025 to 07/2025 with no sustained benefit. Currently no allied health input. Tramadol initiated 02/2025 and continued since. No psychological input to date. **Work and functional status** Hemi is employed as a taxi driver with Tāmaki City Taxis. Pre-injury hours were 45 to 50 per week. He is currently working reduced hours of 20 to 25 per week on a flexible roster. His employer has been highly accommodating, allowing breaks and shift selection that minimises sustained head-turning. He reports difficulty with rear-vision tasks (head checks, reversing) which has reduced his comfort with night driving. Summary of Findings Include an evaluation of all possible causes and contributors to the pain/s. Describe the relationship between the pain the Client is experiencing, and the ACC covered injury. Include information about the Client's cultural considerations, values, and beliefs. This section should provide rationale for the recommended Pain Management Service in Section 3 and estimated timeframes of service. Taha Tinana. Hemi presents 19 months after a clearly identifiable mechanical neck injury sustained in a rear-end motor vehicle collision, the ACC-covered event. His original injury produced a well-localised right cervical and scapular pain pattern. Over the second six months of recovery, the pain centralised and broadened, with development of allodynia to light pressure over the right paracervical muscles, mechanical hypersensitivity in the upper trapezius, and intermittent paraesthesia into the right upper limb without a corresponding dermatomal pattern. Imaging from 04/03/2025 demonstrated a mild C5-C6 disc bulge without cord or nerve root compression. There are no red flags. Useful cervical range remains (right rotation 50 degrees, left rotation 65 degrees) and shoulder function is preserved. The shift from clearly nociceptive pain in the first six months to widespread mechanical hypersensitivity over the last twelve months is consistent with central sensitisation. The relationship between the ACC-covered injury and the current presentation is complex: the original injury initiated the pain, but does not adequately account for its current distribution, severity, or persistence. He is maintained on tramadol with adjuncts; the duration and dose now warrant proactive opioid stewardship. Taha Hinengaro. Hemi's emotional presentation is dominated by helplessness and a sense of lost agency over his pain, well reflected in his DASS-21 profile (Depression moderate, Stress moderate, Anxiety mild). His PCS profile is helplessness-dominant rather than rumination-dominant, suggesting a defeated stance toward recovery rather than a hyperalert scanning for danger. PSEQ at 22 out of 60 confirms low confidence in functioning despite pain and identifies this as the central modifiable barrier. He shows good insight, is help-seeking, and engaged constructively throughout the triage interview. Sleep is fragmented but does not meet criteria for a primary insomnia disorder. Taha Wairua. Hemi's identity is deeply tied to his role as a provider for his whānau and as a working man in his community. The prolonged reduction in his work capacity has eroded that sense of purpose. He speaks with regret about no longer being the person his family relies on, and with frustration that he cannot enjoy activities that previously grounded him (touch rugby, hāngi preparation, gardening). He has not lost hope, but his hope is conditional on a path back to function. Being useful to whānau and community again is his stated primary motivator. Taha Whānau. Hemi lives with his wife Ngaire and two adult children. His wife is supportive but reports feeling helpless watching him struggle; some relational strain exists around irritability and reduced participation in shared activities. His employer (Tāmaki City Taxis) has been accommodating, holding his role at reduced hours. He has retained close contact with his rugby club whānau even while not playing. The social environment is broadly supportive of recovery rather than reinforcing illness behaviour. Whenua. Hemi self-identifies as Māori, with affiliations to Ngāti Porou (paternal) and Te Rarawa (maternal). He has consented to inclusion of his iwi affiliations in this report. He prefers English in clinical settings but values the use of te reo greetings and basic kupu where appropriate. He has indicated interest in connection with kaupapa Māori health resources during the programme and would welcome the option of a kaiāwhina or cultural support person at IDT review points. Cultural safety planning has been initiated at triage and will be confirmed at intake with the programme team. Formulation. Hemi presents with a centralised pain syndrome maintained primarily by neurophysiological sensitisation, low pain self-efficacy, depressive mood and helplessness, and the long-term impact of opioid use. Without intervention, the trajectory is one of slow deconditioning, escalating opioid reliance, and progressive disengagement from work and identity-affirming activities. With intervention focused on graded reactivation, opioid tapering under medical oversight, cognitive-behavioural work targeting helplessness and self-efficacy, and culturally responsive engagement, his prognosis for functional gain is moderate to good. Community Services Level 2 is recommended on the basis of the multidimensional drivers, the opioid burden, and the requirement for combined medical and psychological input. Estimated programme duration is 16 weeks, with a midpoint IDT review at 8 weeks. List of medicines | Medication | Dose | Frequency | Prescribing Clinician | Notes | |------------|------|-----------|----------------------|-------| | Tramadol | 50 mg | Up to four times daily as required (averaging 150 to 200 mg per day) | Dr Sue Patterson, GP | OPIOID. 18 months continuous use. Tapering plan required as a programme priority. | | Amitriptyline | 25 mg | Nightly | Dr Sue Patterson, GP | Adjuvant for neuropathic pain modulation and sleep. | | Paracetamol | 1000 mg | Up to four times daily as required | Dr Sue Patterson, GP | Adjunctive analgesic; no concerns. | | Diclofenac topical 1% gel | Pea-sized amount | Up to four times daily to neck and shoulder | Dr Sue Patterson, GP | Adjunctive; well tolerated. | | Metformin | 1000 mg | Twice daily | Dr Sue Patterson, GP | For type 2 diabetes; not directly relevant to pain presentation. | Summary of ePPOC results Hemi's pre-triage ePPOC battery (completed 12/05/2026) describes a multidimensional pain experience consistent with chronic high-impact pain. BPI: Pain severity composite of 6/10 and pain interference composite of 7/10 reflect substantial functional impact across daily activities, mobility, sleep, work, and enjoyment of life. The interference composite exceeding the severity composite is characteristic of central sensitisation presentations, where disability is driven more by the system's response to pain than by raw nociceptive input. DASS-21: Depression 14 (Moderate), Anxiety 8 (Mild), Stress 18 (Moderate). The depression-stress signal is more elevated than the anxiety signal, painting a picture of grinding low mood and felt overload rather than acute worry. This is consistent with the helplessness-dominant pattern seen on the PCS and contextualises the impact of his prolonged time at reduced work hours. PCS: Total 28 out of 52, placing Hemi in the moderate catastrophising range. The dominant subscale is Helplessness (12/24), with lower contributions from Rumination (9/16) and Magnification (7/12). The implication for programme engagement is that interventions targeting agency, self-efficacy, and small experiential wins will be more effective than interventions targeting attentional patterns alone. PSEQ: 22 out of 60, reflecting low pain self-efficacy. Hemi does not currently believe he can do what matters to him while pain is present. This is the central modifiable barrier to functional recovery and the primary target for the cognitive-behavioural components of the programme. Opioid flag: Hemi has been on tramadol for 18 months with an average daily dose in the 150 to 200 mg range. There are no current concerns about misuse, however the duration and dose warrant a structured tapering plan with medical oversight as a programme priority. Continued opioid use at this level is unlikely to be supporting his functional recovery and may be contributing to mood and cognitive flattening. Date of Triage: 14/05/2026 Date of IDT Review: 21/05/2026 | Role | Name | Discipline | |------|------|------------| | Triage Clinician and IDT Member | Dr Ruth Coleman | Pain Medicine Specialist | | IDT Member | Dr Toni Webb | Clinical Psychologist | | IDT Member | Maia Henare | Physiotherapist | **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 Ruth Coleman **Signature:** **Date:** 22/05/2026 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, ePPOC scores: BPI severity composite stated verbally as "six out of ten" and interference as "seven out of ten"; verify both against the documented BPI questionnaire from 12/05/2026 before submission. - Section 4, Iwi affiliation: Hemi consented during triage to inclusion of his Ngāti Porou and Te Rarawa affiliations in this report; confirm at IDT review that consent extends to sharing with the programme team and any kaupapa Māori health partners engaged during the service. - Section 4, Tramadol average daily dose: stated as "150 to 200 milligrams per day"; confirm with Dr Sue Patterson's prescribing records and Hemi's recent dispensing data before submission.