621: Mapping Referral Pathways To A Tertiary Pain Clinic In Sri Lanka: Retrospective Observational Study

Topic: Education, Societal Impact, and Others
Subtopic: Organisation of clinical pain care

Background and Aims: Chronic pain is a leading cause of disability affecting the quality of life. Sri Lanka has a limited number of pain clinics attached to tertiary care centers. Organized referral pathways play an important role in improving care and overcoming the disadvantage of limited access. Understanding referral pathways, timing and reason for referral is important to improve access, efficiency and equity of pain care in low and middle-income settings. The objective of this study is to describe referral pathways, timing, and reason for referral to a tertiary pain clinic and to identify delays and system-level barriers to timely specialized pain care.

Methods: A Retrospective observational study was conducted at the multidisciplinary pain Medicine unit of Teaching Hospital Peradeniya, Sri Lanka. Consecutive new referrals during 2025 were analyzed. Data were collected from the first clinic visit records, including demographic characteristics, referral source , diagnosis, duration and severity of pain, prior treatments, and reasons for referral. Time intervals from symptom onset to specialist referral was analyzed using descriptive statistics and subgroup comparisons to identify factors associated with delayed referral. Descriptive statistics were used to characterize pathways, and subgroup comparisons were performed to identify factors associated with delayed referral.

Results: 90 referrals were received with a mean age of 57.1 years and equal gender distribution during the year 2025. The main indication was Musculoskeletal pain(62.2%) followed by chronic cancer pain (11.1%) and neuropathic pain(10%). Most referrals originated from orthopedics and oncology services, with minimal contribution from primary care and peripheral hospitals. Timely referral occurred in 56.7% , while 43.3% experienced delayed referral, due to lack of awareness and absence of structured referral pathways. A significant proportion(62.2%) of patients had pain more than six months with multiple other clinic visits. More than 80% received multiple pharmacological treatments without structured pain assessment.

Conclusions: Referral to specialized pain care in Sri Lanka commonly occurs later in the disease course, following prolonged symptom burden ,fragmented management and symptomatic treatment without proper pain assessment. Mapping referral pathways highlights key opportunities for earlier identification, clearer referral criteria, and strengthened links between primary, secondary, and tertiary care. These findings can make awareness on the importance of developing streamlined referral models. It supports the expansion of organized pain services in similar resource-limited settings and also attached main tertiary care centers island wide.

References: 1. Di Renna T, Burke E, Bhatia A, et al. Improving access to chronic pain care with central referral and triage: The 6-year findings from a single-entry model. Can J Pain. 2024;8(1):2297561. Published 2024 Jan 12. doi:10.1080/24740527.2023.2297561
2.
1. Hearn JH, Martin S, Smith M. Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain. British Journal of Pain. 2022;17(1):71-86. doi:10.1177/20494637221132451

Presenting Author: Ashani Ratnayake
Submitting Author: Ashani Ratnayake

Senior Author: Ashani Ratnayake

IASP 2026 Global Year theme of Neuropathic Pain: No

• Ayodya Kariyawasam: MBBS - Teaching Hospital , Peradeniya, Sri Lanka