Physiotherapy — Referral to Pain Clinic for Chronic Low Back Pain
A physiotherapist refers a 47-year-old woman with chronic low back pain and signs of central sensitisation to a specialist pain clinic after a 16-week course of evidence-based physiotherapy. This proficient case contains a detailed treatment log, psychological co-morbidities, and social stressors — the challenge is to present the clinical reasoning for referral clearly while cutting the historical detail that does not change the pain specialist's decision.
Letter type
Referral
Write to
Pain Specialist / Consultant
Target length
200–230 words
The case notes
Patient: Mrs Yolanda Ferreira, 47 years old, primary school teacher on reduced hours
History: 3-year history of chronic low back pain, non-specific; no radiculopathy; MRI (18 months ago) — L4-L5 mild disc degeneration, no significant nerve compression; never required surgery
Assessment at referral to physio: Fear-avoidance beliefs present (FABQ physical score 26); widespread allodynia; pain catastrophising (PCS 38/52); sleep disrupted
Treatment provided (16 weeks): Cognitive-behavioural pain management programme, progressive graded exercise, sleep hygiene education, pacing strategies; 12 individual sessions
Response: FABQ score reduced to 18; sleep somewhat improved; but still pain NRS 7/10 average, PCS 31/52 — persistent high catastrophising despite improvement; unable to return to full hours at work
Indicators of central sensitisation: Allodynia, widespread hyperalgesia beyond L4-L5 territory; poor response to mechanical treatment; pain maintains despite exercise improvements
Psychological: Generalised anxiety disorder (on sertraline — GP-managed); marital difficulties (disclosed, not clinical); catastrophising measured objectively
Referral reason: 16-week evidence-based trial with significant but insufficient functional recovery; central sensitisation features suggest benefit from a multidisciplinary pain specialist approach
Task: Write a referral letter to the pain clinic specialist, Dr Amira Hassan, summarising the physiotherapy findings and the rationale for specialist referral.
Writing task
Write a referral letter to the pain clinic specialist, Dr Amira Hassan, summarising the physiotherapy findings and the rationale for specialist referral.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The 16-week evidence-based treatment programme and the outcome: FABQ and PCS scores at start and end
Quantified outcome data is the core of a physiotherapy referral to a specialist. The scores show partial but insufficient improvement — the precise justification for escalation rather than more of the same treatment.
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The clinical indicators of central sensitisation
This is the physiotherapist's unique diagnostic contribution: allodynia, widespread hyperalgesia beyond the imaging territory, poor mechanical response. These explain why routine physiotherapy has reached its ceiling and why a pain specialist approach is indicated.
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That she remains unable to return to full hours at work
The functional impact of the ongoing disability tells the specialist the stakes — this is not a mild complaint. It frames the urgency and the functional goal of referral.
Leave out
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The marital difficulties
Disclosed in a therapeutic context and not a clinical finding the pain specialist requires. Psychosocial stressors can be noted as a category; identifying the specific personal situation in a referral letter is a privacy breach and irrelevant to the specialist's assessment.
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The 18-month-old MRI findings in detail
Noted for context; the specialist will order updated imaging if needed. 'Prior MRI shows mild L4-L5 disc degeneration without significant neural compromise' is one sentence. Detailed MRI reporting is the radiologist's domain.
Criterion in focus · Content
Physiotherapy referrals to specialist services are graded on clinical reasoning, not clinical information volume. The examiner asks: has the physiotherapist explained why this patient needs a pain specialist, not more physiotherapy? The answer must be in the objective data — the treatment delivered, the measured response, and the central sensitisation indicators. Opinion without data is not sufficient.
Now write the letter — and find out what is blocking your Grade B
Write a 200–230 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.