|"Up to 80 percent of people living with chronic pain are missing out on treatment that could improve their health and quality of life."
- National Pain Strategy, 2010
Management of pain, especially chronic pain, is one of the most seriously neglected areas of healthcare in Australia, especially in regional and remote communities.
The National Pain Strategy, supported by more than 150 healthcare and consumer organisations, provides a blueprint for addressing this situation.
A key role for Painaustralia is to advocate for wider access to appropriate treatment for pain, and more effective help for people living with pain, which includes improvements in training and education of healthcare professionals.
We liaise with Federal and State Government representatives as appropriate, prepare submissions in relation to government policies and programs, and work with consumer organisations to address issues affecting people living with pain.
- There is significant unmet demand for pain services which will worsen as the population ages. Currently, fewer than one in ten of the 3.2 million people who suffer chronic pain – such as back pain or persistent pain after surgery – get access to effective treatment.
- Patients face long waiting times to access multidisciplinary services in public hospitals - frequently more than one year, resulting in a deterioration in quality of life and psychological wellbeing, and long term disability with reduction in the capacity to return to work. (See Waiting in Pain Project – Australian Pain Society 2010)
- Nationally, there are only 24 registered pain specialist training positions, whilst Palliative Care has twice this number (50 nationally) and Psychiatry has 102. Funding is urgently needed for more training positions. In addition, there are only 20 accredited training units in public hospitals across the country.
- Funding for specialist pain clinics in major teaching hospitals has been patchy and precarious. All of the nine clinics in NSW have been forced to reduce services significantly in recent years. A number of units have been threatened with closure, including those at Westmead, Lismore and St George Hospitals.
- Significant service gaps exist across patient groups including vulnerable groups – older people, children, indigenous people, cancer patients, mental health patients, women with pelvic pain.
- Services vary widely through the country – between states and within states, between metropolitan and regional and remote areas and between different types of patients.
- Training resources are inadequate to meet both current and future demand, resulting in long waiting times for many patients. This situation is not the fault of medical colleges. The Faculty of Pain Medicine and ANZCA are willing and able to train more doctors. The missing link is funded positions for interns, prevocational doctors and trainees in our public and private hospitals. These doctors, in turn, will be in a position to help train other health professionals.
- Australia is at the forefront internationally in developing this specialist area through the Faculty of Pain Medicine (FPM), part of the Australian and New Zealand College of Anaesthetists (ANZCA). The Faculty – a world first – includes five medical specialties: anaesthetists, surgeons, psychiatrists, physicians and specialists in rehabilitative medicine.
- There appears to be minimal coverage by private health insurers of ambulatory multidisciplinary pain management. Current reimbursement and insurance arrangements tend to favour more expensive invasive procedures (often with limited evidence of effectiveness) over effective less invasive, less expensive cognitive behavioural programs.
- The Federal Minister for Health and Ageing recognised pain medicine as an independent medical speciality in 2005, resulting in specific items included in the Medical Benefits Schedule (MBS) in 2006 for medical practitioners recognised as a Fellow of the Faculty of Pain Medicine. However, the limitations imposed fail to promote an appropriate service model based on an interdisciplinary approach and strong links to the primary care level in order to encourage continuing management of less complex cases in a primary care setting. For example, item numbers exist for services provided by psychologists when referred by GPs and psychiatrists. However, there is currently no rebate for a direct referral from a pain medicine specialist to a psychologist with special expertise in the management of chronic pain, which would facilitate the development of multidisciplinary management in private practice, promote greater efficiency within the health system, and be of great benefit to patients who would no longer have to make an additional visit to a GP to obtain such a referral.