Cauda equina, asked every time
Saddle anaesthesia, bladder or bowel disturbance, bilateral leg symptoms and progressive weakness screened on every contact regardless of the reason for the call, with immediate escalation on any positive finding.
Specialty · Pain Management
Opioid reviews that happen on schedule, every time.
Structured pain and function assessment, controlled-substance monitoring with the checks your policy requires, tapering support, and procedure follow-up — with cauda equina questions on every contact.
- 98%
- Controlled-substance reviews on schedule
- < 45s
- Cauda equina features to escalation
- 2.7x
- Function scores captured per patient
In the product
Pain service — review 8841
EscalatedOutbound 13:05 · Colm R. · 49 · oxycodone MR 20mg bd · review due
Primum
Before the review questions — any change in bladder or bowel control, or numbness between your legs when you sit down?
Caller
Now that you say it, the last few days it's been numb when I sit on the toilet. And I've had to wait to start going.
Saddle anaesthesia + urinary hesitancy → cauda equina criteria met, review suspended
Primum
That combination needs to be assessed today. I'm arranging emergency assessment now and the spinal team is being contacted — don't wait to see if it settles.
Review deferred · emergency pathway opened · prescriber notified
Review record
- Regimen
- Oxycodone MR 20mg bd
- Saddle sensation
- Reduced, 3 days
- Bladder
- Hesitancy reported
- Criteria
- Cauda equina — emergency
- Review
- Suspended
- Spinal team
- Contacted 13:08
Emergency assessment arranged · prescriber informed · review rescheduled
Overview
The review that gets skipped is the one the policy depends on.
- Pain and function scored with the same instruments at every contact, so the trend is real.
- Controlled-substance obligations met on schedule rather than when a slot appears.
- Cauda equina and other spinal emergencies screened on every contact, without exception.
Controlled-substance prescribing carries obligations: regular review, function as well as pain, agreement compliance, database checks, and a documented rationale for continuing. Every one of those takes a clinic appointment that a busy service cannot always find, so the prescription is reissued and the review slides another month.
Primum runs those reviews as structured contacts. Pain and function are scored with the same instruments each time, agreement terms are checked, aberrant patterns are surfaced rather than smoothed over, and the prescriber sees a decision with the trend attached. Tapering is supported with contact at the intervals that make it survivable, and cauda equina questions are asked on every single call.
Capabilities
Four things a pain service has to keep doing
Three are obligations. One is an emergency that presents as ordinary back pain.
Pain and function, both
Numerical pain scores alongside functional measures — what the patient can do now that they could not, or can no longer do — so decisions rest on function rather than on a single number.
The monitoring your policy requires
Agreement compliance, prescription database checks, toxicology scheduling, early-request patterns and lost-prescription frequency, all surfaced with the history rather than reported as isolated events.
Tapering that people survive
Contact at each step down, with withdrawal symptoms, sleep, mood and function tracked, and the ability to hold a step rather than abandon the taper when it gets difficult.
How it works
A controlled-substance review, done properly
The same structure every time, which is what makes the trend worth reading.
- Arrives
- Decided
- Done
- Returned
01
Review due
Triggered by the prescribing interval, with the current regimen, agreement terms and last review loaded.
Interval trigger
02
Red flags screened
Cauda equina and progressive neurological features asked first, on every contact, before the review itself begins.
Spinal red flags
03
Scored and checked
Pain, function, side effects, adherence and agreement compliance captured, with database and early-request patterns evaluated.
Instrument + policy
04
Decision prepared
Continue, adjust, taper or review in person, with the trend, the evidence and the rationale assembled for the prescriber to sign.
Prescriber decision
01
Review due
Triggered by the prescribing interval, with the current regimen, agreement terms and last review loaded.
Interval trigger
02
Red flags screened
Cauda equina and progressive neurological features asked first, on every contact, before the review itself begins.
Spinal red flags
03
Scored and checked
Pain, function, side effects, adherence and agreement compliance captured, with database and early-request patterns evaluated.
Instrument + policy
04
Decision prepared
Continue, adjust, taper or review in person, with the trend, the evidence and the rationale assembled for the prescriber to sign.
Prescriber decision
Benefits
Compliance and care improve together
Which is rare — usually one is bought at the expense of the other.
The documented review exists
Every continuation has a scored assessment, a compliance check and a rationale behind it. That is what an audit asks for.
Function is visible over time
A patient whose pain score is unchanged but who has stopped leaving the house is a different clinical problem, and the trend makes it visible.
Tapers finish more often
Contact at each step, and permission to hold one, is the difference between a completed taper and an abandoned one.
In practice
Four pain service contacts
The first has nothing to do with the review it was booked for.
Numbness when sitting
Emergency in 40sMentioned during a routine review. Saddle anaesthesia with urinary hesitancy meets criteria and emergency assessment is arranged immediately.
Early request, third time
Flagged with historyPattern surfaced with the previous two requests and the database check, and routed to the prescriber rather than reissued.
Taper step 4 of 8
Held one cycleSleep and mood deteriorating. The step is held rather than abandoned, with a further contact in two weeks.
Post-injection, day 3
ReassuredExpected post-procedure flare with no red flags. Advice given and the next review confirmed.
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Audit your review interval
Ask how many controlled-substance patients have a documented, scored review inside the interval your policy states. We will run one month of them and show you the difference.