Building the Bridge: A Framework for Collaborative Referral Pathways between Palliative Medicine and Interventional Pain Specialists

Pain remains one of the most challenging symptoms in patients with serious and advanced illness. Palliative medicine teams frequently manage complex pain using pharmacologic and nonpharmacologic approaches, while interventional pain specialists can provide targeted procedures for selected patients with refractory or anatomically defined pain. Despite complementary expertise, referral between these disciplines is not always straightforward. Patients may be referred late in the course of illness, clinicians may be unfamiliar with available procedures, and communication regarding prognosis, functional status, goals of care, and procedural feasibility may be incomplete. This narrative review proposes a practical framework for collaboration between palliative medicine and interventional pain services. The framework is designed to help clinicians recognize patients who may benefit from an interventional pain consultation while preserving the central role of individualized goals-of-care discussions. Potential interventions include neurolytic and anesthetic nerve blocks, intrathecal drug delivery, vertebral augmentation, and other targeted procedures. Rather than establishing a rigid clinical decision rule, the proposed pathway provides a structured approach to recognizing referral triggers, performing a focused bedside assessment, discussing goals and expectations, communicating a specific clinical question to the interventional pain team, and maintaining follow-up after consultation. Early and appropriate referral does not necessarily mean that a procedure will be performed. In some patients, the most appropriate recommendation may be continued medical management or avoidance of an intervention because of prognosis, procedural risk, functional status, or patient preference. A collaborative pathway can therefore serve not only to increase access to procedures but also to improve communication and ensure that procedural options are considered within the broader goals of serious-illness care.