When is it appropriate to refer patients to a pain clinic — when their pain is refractory to treatment or when they require long-term treatment with pain medication? — SABINA KOENIGS, MPAS, PA-C, San Diego

It is appropriate to refer when a patient’s pain is refractory to your management. Depending on the patient’s condition and your practice site, that referral might be to a chronic pain center or specialist, such as a rheumatologist. Many primary-care practices manage patients who require long-term pain treatment. Any time you or your preceptor are uncomfortable managing chronic pain with medications, a referral is indicated. — JoAnn Deasy, PA-C, MPH (145-11)