Painaustralia eNews Issue 21, 15 May 2013
- National Medicare Locals Roundtable Success
- Pain Hits the Hip Pocket Too: Australians Paying Too Much for Healthcare
- Painaustralia Fact Sheets Out Now
- Medical Observer Tackles Pain
- Professor Michael Cousins AM Receives Lifetime Achievement Award
- The Link Between Pain and the Immune System
- Making Pain "Visible"
- Pi Squared Goes Global
- Raising Awareness About Carers
- Provisional Fellow Positions in Pain Medicine in 2014
The Pain Prevention and Management Roundtable, held in Melbourne in April, brought together more than 70 representatives from Medicare Locals and other stakeholders in a watershed event for pain management in Australia.
Hosted by the Australian Medicare Locals Alliance (AMLA) and Painaustralia, there was an impressive line up of speakers, all willing to share information about their experiences, programs, research and models of care, in order to help one another develop best practice approaches to pain prevention and management in the primary care setting.
Key speakers were Professor Michael Cousins AM, who outlined the main issues identified in Australia's National Pain Strategy, and Professor Michael Nicholas, who focused on the multidisciplinary approach to pain management.
Elizabeth Carrigan, CEO of the Australian Pain Management Association, addressed the need for delivery of community education to improve health literacy, while Jenni Johnson from the NSW Agency for Clinical Innovation Pain Network spoke about models they have developed in order to create linkages, cooperation and integration between the different tiers of healthcare.
Medicare Locals that presented their models for better pain management were Perth North Metro Medicare Local, Greater South Brisbane Medicare Local and Western Sydney Medicare Local.
Ms Carrigan said it was a pivotal event. "I believe in the future we will be able to look back on it as a watershed event, the moment when everyone finally realised what could be done, and how it could be done," she said.
"With some goodwill and leadership shown by the AMLA, it will be possible to get these best practice models to the 80 percent of Australians who don't currently have access to pain services," said Ms Carrigan.
Painaustralia CEO Lesley Brydon, who also spoke at the event, said there are excellent initiatives already occurring, but that the work is patchy, and it is vital for pain to become a national health priority, which will allow an expansion of work.
Slides from the roundtable are available from the AMLA website here.
Pain Hits the Hip Pocket Too: Australians Paying Too Much for Healthcare
Australians pay twice as much as people in Britain or France, behind only Switzerland, Greece, the US and Belgium, according to a report released by the Consumers Health Forum.
The report found that a typical Australian family pays $500 in doctors' bills every year, to meet the gaps not covered by Medicare, and a further $1200 a year in over-the-counter medicines not subsidised by the government.
While the major political parties claim to support affordable access to healthcare for all Australians, the reality for many households is different, not least for people who have chronic pain.
For the 3.2 million Australians living with chronic pain, the seemingly endless stream of doctors' appointments, medications and treatments can drain personal finances.
The seminal study into the economic burden of chronic pain, The High Price of Pain, found the most significant compounding factor is the effect on people's ability to work, and therefore be economically productive.
This was highlighted recently in Professor Deborah Schofield's study, which found that chronic pain conditions account for 40 percent of forced retirements, pushing many onto the Disability Support Pension.
At the Living Well With Pain Consumer Symposium and Forum held in Canberra in March, consumers identified financial hardship as a key issue. There was a shared view that chronic pain needed to be properly recognised as a chronic health condition and not just a symptom, for it to be effectively covered by Medicare item numbers, PBS listings, the Disability Support Pension, Carers' Allowance, and more.
With timely intervention in the disease process essential for reducing people's level of disability and reducing their long-term health expenses, the financial burden could be lifted with better access to effective healthcare, in particular, multidisciplinary pain clinics.
However, while some progress is being made, for most Australians access to public healthcare remains limited and wait times are frequently more than a year.
As the prevalence of chronic pain in Australia is expected to rise with an ageing population – from 3.2 million in 2007 to 5 million by 2050 – the time for us to act is now.
It is imperative that a Federal Government understand both the economic and social costs of chronic pain, and make pain a national health priority.
Download the current Consumer Voices magazine to read more about out-of-pocket expenses and their impact on access to healthcare, and on people living with chronic pain.
Painaustralia Fact Sheets Out Now
Painaustralia has produced a set of fact sheets for GPs and other healthcare professionals who would like to better equip themselves to identify and manage chronic pain in their patients.
Based on best practice evidence-based approaches to dealing with chronic pain, they will provide a useful reference tool.
The fact sheets cover the following topics: the nature and science of pain; the prevalence and cost of pain; the clinical assessment of pain; and the multidisciplinary management of pain.
They were reviewed by Painaustralia Clinical Representatives Professor Michael Cousins AM and Associate Professor Milton Cohen, along with Community Director Diana Aspinall.
They draw from highly regarded sources, including Professor Cousins' award winning book Fast Facts: Chronic and Cancer Pain, which he co-authored with Professor Rollin Gallagher.
The fact sheets were produced with the assistance of an educational grant from Bristol Myers Squibb and can be downloaded from the Painaustralia website here.
Medical Observer Tackles Pain
The Medical Observer focused on pain in its recent 26 April edition, addressing a range of issues including opiate addiction, pain management and paediatric pain.
Almost one in five GP consultations involve a patient with chronic pain – 60 percent for musculoskeletal pain – and over the past decade the prescribing rate for opioids has increased significantly.
In her editorial, Medical Editor Dr Libby Harris wrote, "There's no denying the importance of the GP in the management of pain and dependency in the community and the role we can play in providing effective pain relief cannot be underestimated."
However, the traditional model of care, where the source of pain is treated and the patient is pain-free, does not generally apply to chronic pain.
For people with persisting pain, there is strong evidence that the experience of pain is influenced by psychological and environmental variables, in addition to any underlying medical condition.
A multidisciplinary approach to pain management consists of treating every aspect of the chronic pain experience. It involves physicians working with a team of other healthcare professionals to generate a person-specific pain management plan, and there is growing evidence of its effectiveness in the treatment of chronic pain.
Multidisciplinary pain management is a key focus of the National Pain Strategy, and more needs to be done to ensure every Australian can access this kind of treatment, in a timely way.
Professor Michael Cousins AM Receives Lifetime Achievement Award
Painaustralia would like to congratulate Professor Michael Cousins AM upon receiving the The Australian & New Zealand Neuromodulation Society Lifetime Achievement Award.
The inaugural recipient of this award, Professor Cousins' work in nueromodulation has spanned more than 40 years.
In the 1970s and 1980s, Professor Cousins undertook seminal research on the scientific basis and clinical use of the morphine-like drugs administered by the spinal route. A major review article of his research group's key findings, and those of others internationally, remains the most cited paper in the Anaesthesiology literature of the past 60 years.
The award also recognised the more recent work of Professor Cousins, in particular, his collaboration with a group from NICTA headed by Dr John Parker, which has been pioneering a new understanding of the mechanisms of action of spinal cord stimulation leading to highly innovative developments in this field of neuromodulation.
Earlier this year, Professor Cousins was invited to the Scientific Meeting of the Faculty of Pain Medicine in Ireland, which addressed where he delivered the RYND Lecture entitled "The Future of Pain Medicine". The theme of the meeting was "Chronic Pain as a Chronic Disease" and Professor Cousins made a key presentation on this topic. In recognition of Professor Cousins' contribution to the field of Pain Medicine, he was made an Honorary Fellow of the Faculty of Pain Medicine of Ireland.
While in May, Professor Cousins was invited as the key plenary lecturer at a combined meeting of all the Asian Associations of Pain Medicine. The invitation to participate in this meeting was partly in recognition of the many Fellows Professor Cousins has trained from the Asia/Pacific region. As Professor Cousins recognised in his lecture, the training of key individuals who return to their countries of origin with new knowledge and expertise has a multiplier effect in terms of benefit.
Professor Cousins is well deserving of this recognition and we are very fortunate to have him continue to be actively involved in the field of pain medicine, not just from a clinical and research perspective, but also at the level of policy development.
The Link Between Pain and the Immune System
At the University of Adelaide, pioneering research is investigating a link between pain and the body's immune system.
Over the past four years, Professor Paul Rolan and Dr Mark Hutchinson have combined their different specialist skills in research they hope will ultimately help to improve treatment of chronic pain.
"All existing drug treatments are neuron-related and target the nerves or wiring of the pain system," said Dr Hutchinson, a pharmacology scientist. "But in chronic pain the treatment is hit and miss and there are a high range of side effects.
"Our research demonstrates that the immune system may be a cause and that for patients with the right set of circumstances, pain medication actually makes their condition worse."
The "eureka" moment in their research occurred when capsaicin – the fiery compound in chillies – was placed under the skin of volunteers. A subtle immune stimulant (endotoxin) was then given intravenously, showing that when the immune system was switched on it made the volunteers more sensitive to pain.
Another breakthrough was the discovery that codeine and morphine-like medications activate the glia immune system to create more pain in people with chronic headache.
And for women complaining of pain during their monthly cycle, the female hormone oestrogen is believed to be activating the immune pain cells.
The research team is now looking at a diagnostic blood test to identify people with an over-sensitive immune reaction to pain, and is assessing medications that might prove helpful.
The team is also testing the possibility of magnetically rewiring the chronic pain affected brain.
Making Pain "Visible"
Researchers from the US claim that they have evidence that pain may leave a distinct "signature" in the brain that can be "seen" with specialised MRI scans.
When researchers exposed healthy volunteers to a painful dose of heat, it left a reliable pattern of brain activity that could be viewed on functional MRI (fMRI) – a type of imaging that charts changes in blood flow through the brain.
This "neurologic signature" was able to predict people's subjective pain ratings with more than 90 percent accuracy, and it distinguished heat-induced pain from other feelings, like warmth and emotional pain.
However the study, which was published in the New England Journal of Medicine on 11 April 2013, looked only at short-term pain in healthy people.
Much prior work has shown that brief "experimental pain" in volunteers is very different to chronic pain in patients thus the neurosignature is different.
An Australian study led by Professors Philip Siddall and Michael Cousins in 2006 identified key brain areas associated with chronic low back pain and compared these findings with the brain of people with no back pain using MRI and MRS (which shows biochemical changes in the brain).
This study reported that the brains of patients with low back pain could be discriminated from those without pain with an accuracy of more than 97 percent.
A later study by the same group made similar findings in people with spinal cord injury and neuropathic pain (nerve damage pain).
The findings suggest there may be a way to objectively measure people's pain, rather than using the current subjective method of asking patients to rate their pain on a scale from one to 10.
This would have particular application where pain self report may not be reliable, such as in cases of mental illness or dementia. It could also complement patients' self-assessment with an objective measure.
Pi Squared Goes Global
Western Australia's Pain Information Initiative (Pi Squared) has launched a Community of Practice (Pain Information) on the US Car Pool Health website.
The Car Pool Health website is a global initiative, focused on disseminating evidence-based information to consumers, by bringing together physicians, healthcare providers, patients and other stakeholders as contributors.
Car Pool Health is run by Communities of Practice, groups dedicated to a particular area of health, and Pi Squared has been given responsibility for the Pain Information category on the website.
Pi Squared co-founder, retired pain medicine physician and rheumatologist Dr John Quintner, said that, aside from the clear educational benefits to people who live with pain, the initiative has other advantages.
"This will give information with an Australian content the potential to spread around the world," said Dr Quintner. "There are also benefits from Car Pool Health's strong linkages to social media, and the interactive nature of the site."
Dr Quintner has already submitted blogs on fibromyalgia, medications, and spinal pain interventions, among others, and is hoping to generate some lively and informed discussions.
Pi Squared is a consortium of volunteers, which includes occupational therapists, physiotherapists, psychologists, and "pain champions".
It was formed to offer educational forums for people living with pain, and to develop interactive educational programs for health professionals, as well as for children, adolescents and their families.
Spearheaded by Dr Quintner along with occupational therapist Jane Muirhead, Pi Squared aims to fill a gap in the community.
"I met Jane at a National Pain Week event in Perth last year," said Dr Quintner. "We talked about the huge gap that exists between hospital-based tertiary pain units and the community-level, in terms of educational resources for people in chronic pain, and we decided to do something about it."
In less than a year and with limited resources, the group has already provided tangible support for people in Western Australia.
There have been six forums for consumers, generating strong attendances of up to 60 people, and project funding for four pilot programs has been obtained for the KOPE (Kids Overcoming Pain Education) program.
With no paediatric pain unit in Western Australia, KOPE will provide much needed support. It is based on the Comfort-ability program at Boston Children's Hospital in the US, and will offer a one-day workshop for each of two age groups, with a half-day follow-up workshop two weeks later.
In August this year, Pi Squared will host a two-day workshop for health professionals, Making Sense of Pain, which has been granted interim accreditation by the Australian Physiotherapy Association.
Pi Squared works under the auspices of Arthritis and Osteoporosis WA, and must raise money in order to fund its work.
Lesley Brydon, Painauastralia CEO, said these kinds of community-based initiatives highlight the need for the Federal Government to make pain a national health priority, with the funding it deserves.
Raising Awareness About Carers
The Australian Government is urging workplaces to become "care aware" by registering as a "Care Aware Workplace".
The National Carer Awareness Initiative, developed by Carers Australia, aims to raise awareness of the 2.6 million Australians who wake up every day to care for someone, and to improve workplace arrangements for unpaid family carers.
Carers Australia will provide information for employers, managers and carers of Care Aware Workplaces, to improve flexibility and support for carers in the workplace.
Carers Australia invites who would like to be recognised and supported as "care aware workplaces" to register with them. After registering, they will be eligible to download resources to implement the Care Aware Workplaces initiative.
Provisional Fellow Positions in Pain Medicine in 2014
Two Provisional Fellow positions in Pain Medicine are being recruited for 2014, at the Pain Management & Research Centre, Royal North Shore Hospital.
The funded positions provide a great opportunity to specialise in pain medicine, at one of Australia's foremost teaching hospitals.
Website address: http://www.health.nsw.gov.au/jobs/
Past Editions of eNews
- Issue 20, 22 April 2013
- Issue 19, 2 April 2013
- Issue 18, 5 March 2013
- Issue 17, 16 February 2013
- Issue 16, 10 January 2013
- Issue 15, 10 December 2012
- Issue 14, 15 November 2012
- Issue 13, 15 October 2012
- Issue 12, 20 September 2012
- Issue 11, 24 August 2012
- Issue 10, 10 August 2012
- Issue 9, 30 July 2012
- Issue 8, 24 July 2012
- Issue 7, 12 July 2012
- Issue 6, 25 June 2012
- Issue 5, 7 June 2012
- Issue 4, 18 May 2012
- Issue 3, 27 April 2012
- Issue 2, 30 March 2012
- Issue 1, 12 March 2012