My first taste of pain and injury was when I was only three years old.We had a car accident and I had my lower lumbar joints damaged as well as whiplash injuries to my neck. No one knew this at the time, though, and by the time I was nine I was having X-rays on my back to find out why I was in so much pain.
It happened on 28 August 2008 at 8.28am. Everything after that is a bit of a blur, but the moment the accident happened will be stuck in my memory forever.
I had two major cycling accidents in the 1980s which caused a spinal fracture and severe whiplash.I quickly got over the accidents and was fine until the early 1990s when I started to have migraines. This gradually progressed to daily migraines by 1996.
I was an advisory teacher when I suffered a spinal injury in 2007 that landed me in a Brisbane hospital emergency department.Thanks to a neurosurgeon, I regained the use of my left leg and the crushing pain eased. 
Harry Perkins, son of Olympic champion swimmer and Painaustralia Director Kieren Perkins OAM, was diagnosed with chronic migraine at the tender age of eleven.
I was nine years old when I damaged the ligaments in my left leg in a hurdling accident.After a year of treatment my leg hadn't healed – in fact the pain had worsened and I was diagnosed with chronic regional pain syndrome. 
My injury happened over two days – August 30-31, 2001 – when I was asked to reorganise the office's new filing system.
I woke up one morning in 1988 with a sore back.As the pain continued to increase, I consulted my general practitioner who referred me to an orthopedic surgeon. After some tests, I was told that there were no problems and that the pain should go away. It didn't.
6 when I was 17. Unrelated to any incident, I began to experience extreme back pain. I later discovered it was a degenerative disease with no cure, but at the time I thought it could just be 'fixed'.
September 23, 2006 was a beautiful, still, sunny autumn day.I was in the UK to visit my elderly mother and other family members and had taken the train to London to visit a friend.
Before my accident, about six years ago, I worked at a prestige car dealership in Brisbane. This work was physically demanding as well as being quite social. We all had to get on well as it could be quite a pressured environment and humour often kept us going.
That Friday in June 1990 began like any other Friday – two adults, three teenagers, family pets, all heading out. I was totally unaware that this was the day "Super Mum" would die and life as I knew it would be over.
Breast cancer is a diagnosis heard all too often these days at 13,000 diagnoses a year in Australia.
In 1962 at the age of 21, Renée was involved in a serious car accident that kept her in an English hospital - in a 40-bed geriatric ward - for nearly two years.
I first incurred a serious back injury at work in 1985. It was not able to be evidence-based for five years (at the time of surgery).
It was during a long jump attempt at my school's athletics try-outs when I was nine that I first hurt myself.As usual, I ran and jumped but as I hit the sand I felt pain in what I thought was my ankle.
I'd survived the traumas of a major motor car accident, the ignominity of a prostatectomy, and the despair and exasperation of three separate cancers and their harsh therapies, but nothing had prepared me for the greatest challenge of my life, dealing with chronic pain
My problems started in the early 1980s with the introduction of computers in most public service departments.In 1986,
"Fortunately", the pain from my neck injury was so severe that it was taken seriously from the start.
I injured my neck in 1993 while attending a Scout Jamboree in Canada as a carer for a child with cerebral palsy.My pain symptoms didn't really show up until 1997 when I started getting lots of neck and arm pain. 
As a chronic migraine sufferer I've lived with pain since I was a small child. With the help of sub-occipital electrodes and an implanted pulse generator (IPG implant) I can now manage my daily pain and rely less on heavy medications.
News
- Winner of ANZCA Media Award announced
- STEPS Wins Accolades at National Primary Health Care Conference
- Global Year Against Visceral Pain
- NSW Pain Management Plan Provides Major Boost to Pain Services, Research & Education
- SBS Insight Program Highlights need for National Pain Strategy
- Guidelines Warn Against Medication Overuse
- Chronic pain may all be in your head
- STEPS: Early Intervention Success
- Education needed to address concerns about misuse of Opioids
- Speaking at Painaustralia's AGM, on 17 April, Dr Simon Longstaff Executive Director of the St James Ethics Centre posed some profound questions
Winner of ANZCA Media Award announced
Australian journalist Christine Jackman has won the 2012 ANZCA Media Award for a compelling and informative story about chronic pain.
"World of pain", the winning entry by former Australian journalist Christine Jackman, appeared in the Weekend Australian Magazine in March and described how many patients continue to suffer pain long after any initial cause has been treated.
Her article was one of 15 entries for the award and was judged the best news story or feature about anaesthesia or pain medicine that appeared in the Australian or New Zealand media in 2012.
To view a media release about the winner, please click here.
To see the winning entry, please click here.
STEPS wins accolades at National Primary Health Care Conference
The STEPS pain program run by Perth North Metro Medicare Local attracted widespread interest at the recent Primary Care National Conference.
A primary care pain program, STEPS (Self Educative Pain Sessions) was a finalist in the National Medicare Locals Awards Program.
The Minister for Health Tanya Plibersek made special mention of STEPS as a leading innovation in primary health care when she launched the Medicare Locals Alliance in August.
The program sparked the interest of the 25 Medicare Locals that have identified pain as a priority area in their Needs Assessments. This has led Painaustralia and the Medicare Locals Alliance to form a Community of Interest to help faciliate establishment of similar programs in other regions.
Developed by the Pain Medicine Unit at Fremantle Hospital, the STEPS Program helps people living with pain to understand the nature of pain and develop effective self-management strategies. The multidisciplinary team also provides individual assessments and care plans, and ongoing support is available as needed.
Delivered at half the cost of a similar tertiary program, the primamry care program has reduced waiting times at Perth and Fremantle pain clinics from 2 years to 2 months and significantly reduced GP visits.
The team at Perth North are committed to mentoring other Medicare Locals and those interested should contact Kylie Birkenshaw This email address is being protected from spambots. You need JavaScript enabled to view it. .
Listen to an interview with Kylie Birkinshaw and Terina Grace from PNMML with Dr Norman Swan on the Radio National Health report.
Global Year Against Visceral Pain
The plight of the 10 per cent of women who suffer in silence from the hidden burden of pelvic pain will be highlighted as part of the Global Year Against Visceral Pain, which begins today.
Visceral pain is pain originating from internal organs, which includes conditions such as irritable bowel syndrome, kidney stones, chronic chest pain, period pain and bladder pain, but the most common condition is chronic pelvic pain, which encompasses a complex range of painful symptoms in both women and men.
Pelvic pain expert, Dr Susan Evans, says pelvic pain is one of the last taboos of modern society, rarely spoken about yet causing huge societal and financial burdens.
"Pelvic pain affects about one in 10 girls and women, but it's hidden," she says. "There's nothing to see on the outside and scans are often normal."
Many of these women have endometriosis, the most common pelvic pain condition, which costs the Australian community $6.6 billion each year in direct medical and surgical expenses, and takes medical specialists on average eight years to diagnose.
Read the media release in full
The Global Year Against Visceral Pain is an initiative of the International Association for the Study of Pain which has produced fact sheets about the condition.
Visceral Pain Fact Sheets
Epidemiology of Abdominal Pain
Acute vs. Chronic Presentation of Visceral Pain
Painful Functional Bowel Disorders: Psychological Factors
Interstitial Cystitis/Bladder Pain Syndrome
Male Chronic Pelvic Pain Syndrome
Functional Abdominal Pain Syndrome
For more information, please visit the International Association for the Study of Pain Global Year Against Visceral Pain website.
NSW Pain Management Plan Provides Major Boost to Pain Services, Research & Education
NSW Minister for Health and Minister for Medical Research, Jillian Skinner, has announced an additional $26 million over the next four years for the NSW Pain Management Plan.
The plan provides continuity of funding to expand the breadth of clinical care for people with pain, in both metropolitan Sydney and regional areas.
Significantly, the plan also provides the first major ongoing commitment by any Australian government to basic clinical pain research through special funding of the Pain Management Research Institute (PMRI).
The PMRI will also be funded to play a key role in pain education, utilising a program recognised internationally as being crucial to improving pain care at all levels.
This is a significant step towards addressing the recommendations of the National Pain Strategy.
For more detailed information:
- view the NSW Government Media Release
- view the Painaustralia Media Release for Painaustralia's response
- download the NSW Pain Management Plan 2012-2016 (pdf)
- download the NSW Pain Management Report - Report of the NSW Pain Management Taskforce (pdf)
- Listen to the announcement
SBS Insight Program Highlights Need for National Pain Strategy
The SBS Insight program " Accidental Addicts" highlighted the urgent need to implement Australia's National Pain Strategy.
The increasing use of pain medications, including opioids for chronic pain, could be stemmed by improving access to multi-disciplinary pain services, for people with chronic pain, especially in regional and rural Australia.
"Opioids play an important role in the management of acute pain, however they are not suitable for managing chronic pain conditions" said Pain Specialist, Professor Michael Cousins.
Implementation of the National Pain Strategy would ensure better access to education about multidisciplinary approaches to managing chronic pain and access to information and support for people living with pain.
Read the Transcript - the accidental addicts. Does there need to be tighter regulation?
Read an overview of the episode and online comments
Guidelines Warn Against Medication Overuse
The UK National Institute for Health and Clinical Excellence (NICE) has released new guidelines for doctors on diagnosing and managing headaches in young people and adults.The guidelines caution against the overuse of pain medications, with the review panel saying that overuse of analgesic drugs including paracetamol, aspirin, NSAIDS and opioids can cause headaches to worsen.
The Panel states that people who take medications for more than 15 days a month can end up in a "vicious cycle", where their headaches get worse; so they take more medication which can make headaches even worse.
The guidelines advise health professionals to monitor the frequency of use of medications by their patients and caution against overuse.
Chronic pain may all be in your head
Often when people have similar injuries, some end up with chronic pain and others recover. A new study from Northwestern University in Chicago shows that chronic pain develops the more two sections of the brain, related to emotional and motivational behaviour, talk to each other. The more they communicate, the greater the chance that a patient will develop chronic pain.
Read the transcript
Norman Swan: It's believed that up to one in five Australians live with longstanding or chronic pain and a good proportion of those are disabled by it to a significant extent. Some have arthritis, some have cancer related pain and many have what's called a chronic pain syndrome, which can be in almost any part of the body, commonly back pain, headaches, or pelvic or abdominal pain. Whatever caused the pain to begin with has long healed or disappeared and what the person is left with is very real, but hard to treat pain.
It costs them and the nation a fortune in part because many doctors, like their patients, are worried that they might have missed something so the person gets shunted from test to test and from specialist to specialist often undergoing needless surgery which can make things worse.
Pain experts believe that abnormal and self sustaining pain circuits are set up in the brain. It's been a bit of a mystery but a unique study in the United States seems to have illuminated the path that some people take.
Vania Apkarian is Professor Physiology at Northwestern University in Chicago.
Vania Apkarian: The study is specifically designed to understand what in the brain happens when people develop chronic pain and what things in the brain determine why people develop chronic pain.
Norman Swan: And how did you define chronic pain?
Vania Apkarian: Chronic pain is in fact not well defined, it is essentialy pain that persists past the initial injury related healing processes in a sense that usually an injury will cause pain and as that injury heals the pain will go away with it. However in a small number of people that pain may persist and it can in fact last for a whole lifetime.
Norman Swan: What did we know before this study?
Vania Apkarian: For the last ten years or so we have pioneered a whole variety of studies and other people have also contributed to the idea that the pain is changing with chronic pain, it changes for different types of chronic pain conditions and it seems to change both anatomically and physiologically.
Norman Swan: So when you say anatomically you mean physical structures change and also the way the nerves operate change?
Vania Apkarian: Yes literally the structure of the brain is changing with chronic pain, different regions of the brain are decreasing in their size and we think that is only a reflection of synapses changing in different areas of the brain as people are coping or suffering with chronic pain over many, many years.
Norman Swan: And when you say synapses you're talking about the junctions between nerves and the networks of nerves in the brain?
Vania Apkarian: That's right, the connections of neurons and how they talk with each other, how often they talk to each other, how strong are these connections, we think are changing when people continue to live with chronic pain.
Norman Swan: The trouble with that past research which found difference in the brain function between people with and without chronic pain is that they've been snapshots at a moment in time. And that relies on a lot of assumptions and doesn't tell you for example what these people's brains looked like before they developed chronic pain.
This study followed a group of people with back pain from not long after the time of their injury to see what happened inside their brains. Vania Apkarian again.
Vania Apkarian: This is the first study that I know of that we followed the brain anatomically and physiologically over time for a population of patients that all begin with essentially the same amount of pain, the same duration of pain and the same intensity of pain. And then we followed these patients. These are all what we call sub-acute back pain in a sense that the pain has persisted for between 4 to 12 weeks and it's intense enough that we would enter them into the study and we followed them for a year. And we scanned their brains for its anatomical properties and its physiological properties.
Norman Swan: How many people did you study?
Vania Apkarian: 39 patients that we have completed.
Norman Swan: And what proportion of the people went on to having pain at 1 year?
Vania Apkarian: About 50% of the patients that started the study continued to have exactly the same pain that they entered with one year later while the rest of them recovered.
Norman Swan: In a sense you pre-selected a group who hadn't got over their acute back pain quickly anyway and so 50% from their point of view were unlucky enough to continue to get chronic pain. And what did you see in their brains?
Vania Apkarian: First of all we see in the patients where the pain goes away the brain shows no abnormalities and the brain properties look the same as in healthy subjects. So that's a real surprise in a sense that it's not simply because of the pain that the brain is changing it seems to be changing only in the patients where the pain is persistent.
Norman Swan: And the brains were similar at the beginning of the study, when you looked at all 39 people give or take all the variation that you get in brains anyway they looked pretty similar at the beginning of the study?
Vania Apkarian: They looked similar to each other. They also looked similar to healthy subjects. So anatomically the brains, at least the part of the brain, the grey matter of the brain, which is what we have studied in this specific study, the grey matter density which is a crude measure of the synaptic properties of different regions of the brain, were all looking identical across the two groups as well as in relation to healthy controls. And the ones who then recovered again continued to look like having healthy brains, on the other hand the ones who continue to have the pain we see a continuous decrease from entering into 1 year later, those subjects show continuous decrease in grey matter density which we think is a reflection of again the synaptic contacts, how strong these contacts are and how they are shifting in time over that whole 1 year period.
Norman Swan: But in specific parts of the brain?
Vania Apkarian: In various specific parts of the brain and those parts of the brain are areas that we think have to do with in fact the change in the perception of pain and the pain becoming more of a chronic condition. And that simply says that the brain does reorganise specifically as the pain becomes chronic.
Norman Swan: The really fascinating thing though was which parts of the brain were caught up in this process. It turned out that only in the people who developed chronic pain; the place where the pain was registering in the brain developed a relationship with what's called the prefrontal cortex. This is where we make decisions and exert control over our emotions and behaviour.
Vania Apkarian: The practical benefit is that now we can identify targets for future therapy, drug development etc. For the first time we have a causal link between the brain anatomy, brain physiology and chronic pain.
Norman Swan: What predicted the people who went on to chronic pain getting these brain differences? What was it about them – did you measure anything else about these people?
Vania Apkarian: We measured many things in these people but what we find that really is the only predictive parameter in this analysis at least, is this amount of interaction between the medial prefrontal cortex and the nucleus accumbens. That's interesting because we know that the medial prefrontal cortex is an area that has to do with emotional assessment of the environment while the nucleus accumbens is an area that has to do with teaching the brain the value of environmental input and modifying synaptic strengths in the brain. So the results of this connectivity suggests that emotional predisposition and all response to the initial injury is in fact causally linked to the re-organisation of the brain's learning pathways that then either results in the pain going away or results in the pain persisting.
Norman Swan: The reason I ask that question of course is that people who've studied chronic pain suggest that if you've had a lot of life changes in the previous year or two, lost your job, had bereavements and so on you are more susceptible to going on to chronic pain. What your doctor does for you and the expectations your doctor gives you about your pain can make a difference about whether you go on to chronic pain and indeed how effectively your acute pain is looked after in the initial injury. If that's badly managed there's a thought that maybe you can go on to chronic pain.
Vania Apkarian: Those predictors are all very weak predictors, compared to this prediction that we find, which in fact is 85% correct. These patients are sub-acute patients, this is their first episode of back pain, at least half of them are not even going to their doctor. This is an important finding in the sense it is for the first time that we are finding a specific brain mechanism underlying pain chronification; and with a very strong predictive outcome.
Norman Swan: And of course you don't know yet how reversible these changes are?
Vania Apkarian: Well we do know some in a sense that other studies have shown in chronic pain stages for example when the pain is properly treated some of these changes are reversed. So the anatomical changes that we observe in the brain seem to be causally related to the state of the chronicity of the pain. When chronic pain is present these regions are reflecting that chronic pain state and when that chronic pain is treated properly at least some of these areas do seem to at least partially recover. We are very excited with these results and in many ways we are surprised as to how robust these results are. This is a very expensive study, we've spent about 5 years collecting this data and it was only possible by a huge NIH grant and in fact NIH has now funded us on the next stage to use these results to be able to test for new potential therapies, either for prevention of chronification and/or the treatment of the chronic pain.
Norman Swan: Vania Apkarian is Professor of Physiology at Northwestern University in Chicago.
Reference: Baliki MN et al. Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience 2012;15:1117-1119
STEPS: Early intervention success
A program called Self Training Educative Pain Session (STEPS) at Perth North Metropolitan Medicare Local has reduced wait times at Pain Clinics at Royal Perth and Fremantle hospitals from up to two years to just two months.Run regularly since November 2011, the STEPS program has also reduced demand for surgery and other more complex and expensive procedures.
STEPS, run as a free service at Perth North Metropolitan Medicare Local, uses a multidisciplinary pain management approach, with each session run by a pain team that includes a clinical psychologist, physiotherapist and pain specialist doctor.
Patients are invited to attend the two-day program with family or carers, where they learn essential knowledge and self management techniques, and there is individual follow up.
Developed by the Fremantle Hospital Pain Medicine Unit, STEPS also encourages the use of local health resources, and demonstrates how early intervention in the primary care setting can create excellent outcomes for patients.
With one in five Australians, including adolescents and children, living with chronic pain, rising to one in three of the older (over 65) age group (Blyth et al. 2001), sustainable pain services at the primary healthcare level are essential in relieving pressure from Australia's busy tertiary systems.
In addition, current evidence indicates that patients with persistent pain who wait longer than six months for treatment experience health deterioration more rapidly than those patients who have access to multidisciplinary pain services, therefore early intervention is very important. (Davies et al. 2011)
With the success of STEPS at Perth North Metropolitan Medicare Local, there is good evidence to support roll-out of the program to other Medicare Locals.
For more detailed information about STEPS:
Read an overview of the program
Read the peer reviewed paper in Pain Medicine 2010
Read the article in the WA Medical Forum
For more information about how you can implement STEPS in your Medicare Local, contact the STEPS Team at Perth North Medicare Local or Fremantle Hospital Pain Medicine Unit.
Education needed to address concerns about misuse of Opioids
"Concern about misuse of prescribed pharmaceuticals and the reported increased prescribing of opioid drugs by GPs, (MJA, April Vol 196.6 p 380-381)highlight the need for improved education for GPs about pain and best practice multidisciplinary pain management strategies, " said Painaustralia CEO Lesley Brydon.
This includes education for people living with pain and their families and carers and the potential for patients to be trained to develop their own knowledge of pain and effective self-management strategies.
Implementation of a national real time opioid monitoring system would also assist to manage inappropriate use of opioids and at the same time help overcome the associated issue of opioid diversion.
These and other recommendations are included in the National Pain Strategy developed in 2010 by over 150 health care and consumer organisations concerned with pain. The strategy contains a comprehensive set of recommendations which call for changes to the health system to allow for:
- Access to best practice pain management education for health professionals and the general population
- Coordination of the care system to ensure timely access to the right support for people living with pain, in the community and at primary care and tertiary levels
- A quality improvement program to address access and standards of care
- A reasonable proportion of dedicated funding for pain research.
The National Pain Strategy reports that 3.2 Million Australians live with chronic pain and this number is set to increase dramatically with the aging population, with one in three older people suffering chronic pain (Access Economics 2007).
Patients face long waiting times to access multi-disciplinary pain services in public hospitals – frequently more than one year – resulting in deterioration in quality of life and reduction in ability to return to work (APS Waiting in Pain, MJA April vol 196.6 386-390).
There is extensive evidence to show that at least half of those with chronic pain also experience depression and thoughts of suicide are common. A 2006 Study found that 21% of people who died by suicide experienced physical health problems, including chronic pain which may have contributed to their death (Suicide Prevention Australia Report April 2012).
Painaustralia was formed as a national not for profit body to work with governments, consumers, health professionals and other stakeholders to facilitate implementation of the National Pain Strategy.
"There is an urgent need to provide education and access to pain services, in particular for people in regional and rural areas, indigenous communities, socio-economically disadvantaged Australians, as well for children and adolescents and the elderly," said Ms Brydon.
Speaking at Painaustralia's AGM, on 17 April, Dr Simon Longstaff Executive Director of the St James Ethics Centre posed some profound questions.
Dr Longstaff, who played a key role in drafting the Declaration of Montreal, calling for Access to Pain Relief as a Fundamental Human Right, asked people to consider whether deliberately inflicting pain or torture, was all that different from standing by and doing nothing to help someone in severe pain.
"When pain relief is withheld and a person allowed to suffer, it is not so much the pain itself that is so dreadful to bear, but the neglect and abandonment, which leads to what political theorist Hannah Arendt so poignantly described as a 'scarification of the soul" said Dr Longstaff.
"It is possible that with the evolution of medicine and the creation of the institutions and structures around it, we have overlooked something as elemental as pain and suffering."
"The work that Painaustralia is doing, including its role in promulgating the Declaration of Montreal, is of profound significance, not just to us, but to the whole world, and signals a return to a true understanding of the human condition.
"Importantly, it acknowledges the intrinsic dignity of all people and that to be indifferent to the plight of others, is fundamentally evil." he said.
A summary of the Painaustralia AGM is attached or can be viewed here.
Listen to Dr Longstaff's presentation or read the transcript.
Read the transcript of Prof Michael Cousins' thanks to Dr Simon Longstaff, following his address to the Painaustralia AGM.
Submission to NSW Workers Compensation Scheme
Painaustralia submission to the Parliamentary Inquiry into the NSW Workers Compensation Scheme recommends early intervention in work injuries to save costs.
Painaustralia submission to the Parliamentary Inquiry into the NSW Workers Compensation Scheme, to draw the Government's attention to a trial program that demonstrates early intervention after injury, for workers at high risk of long term disability and delayed return to work, can reduce compensation costs for this group. In the first year alone, the savings were up to 25 percent, leading to substantially reduced insurance premiums.
The trial was conducted by clinicians at Concord Hospital in collaboration with Professor Michael Nicholas, Director of the University of Sydney Pain Management Research Institute, at Royal North Shore Hospital.
The intervention was closely aligned with key WorkCover priniciples:
- Early, safe and durable return to work.
- Focus on activity and independence.
- Working towards common goals (of worker and employer).
- Regular review of progress and fisk factors.
- Targeted education.
Key elements of the trial involved identifying (within two days of injury) those deemed at high risk of long term disability or delayed return to work using a brief psychosocial screening scale, and an early intervention protocol that included attention to indvidual and workplace factors by medical, psychological and rehabilitation providers.
Painaustralia has recommended an expanded trial be conducted by WorkCover with the view that it will lead to changes in the management of workplace injuries.
Both Painaustralia's and the Pain Management Research Institutes submissions can be accessed via
Employers, unions and medicos debate workers compo on ABC The World Today - 18 May 2012
Listen to Mark Goodsell (Australian Industry Group), Professor Michael Nicholas (Pain Management Research Institute), Mark Lennon (Unions NSW) debate Workers Compensation.
Industry and Health groups unite for a competitive NSW Workers Compensation Scheme
Leading business, industry and health advocacy groups in NSW have joined forces to support the Parliamentary Inquiry into the NSW Workers Compensation Scheme and to call for reforms which ensure premiums are competitive with other states, provide more effective support for injured workers and encourage a faster return to work.
The group is called the Alliance for a Safer and Competitive Workplace and its membership is made up of a cross-section of business, industry and health groups including: NSW Business Chamber, Ai Group, NSW Farmers' Association, Tourism & Transport Forum (TTF) and Painaustralia.
Read the media release
The World Health Organisation has released new WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses.
In a world first, the guidelines address the significance of pain in children, which is often not recognised, ignored or even denied, and frequently under-treated.
International studies indicate that as many as one in four children will suffer chronic pain for a period of 3 months or more. (Ref 1).
Dr John Collins, Head of Department, Pain medicine and Palliative Care at The Children's Hospital at Westmead, says, that although similar studies are not available for Australia, the prevalence here is deemed to be similar.
A study by NSW Health revealed that one in five of the population, including children and adolescents, will suffer chronic pain in their lifetime. (Ref 2)
Studies here have shown that under-treatment of pain associated with surgery and trauma in children is common, (ref 3) whilst some studies report as many as 50% of children with cancer receive inadequate pain control, even in the terminal phase of the disease. (Ref 3).
"Application of the WHO Guidelines in Australia could go a long way towards preventing this lamentable situation "says Dr Collins.
Proper application of the guidelines could change the way that pain in children is managed and avoid unnecessary suffering and the potential longer term consequences of severe pain experienced in childhood.
"The WHO guidelines provide a strong basis for making chronic pain in children a national health priority and so ensuring greater understanding of pain in children and improved pain management practices" says Dr Collins.
The WHO recommends more comprehensive education of health professionals in the management of persisting pain in children.
"There is a great deal of knowledge available, but we need to ensure this is included in the education curricula and the training of all health professionals including those working in primary care, in intensive care units and in medical specialties. Pain management is the responsibility of every clinician working in the health care system" Said Dr Collins.
"Chronic pain can have a profound impact on a child's future. Untreated chronic pain is likely to result in low school attendance, poorer grades, and cessation of sporting or other school activities".
"For some children, the result is social isolation and depression; and there is a significant risk of transition to chronic pain in adulthood, with its associated suffering and costs to the health system."
Swimming legend and Painaustralia Director, Kieren Perkins understands first-hand the impact of pain in children; his son Harry was diagnosed with a severe form of migraine at age 11.
"Harry's migraine affected his school work and interactions with his peer group, and remains a problem that must be monitored and managed with due care and empathy." says Perkins.
"Children often fall under the radar because they don't understand their bodies and can't communicate effectively in terms of what they feel."
References:
1. Perquin et al 2000 Pain in Children and Adolescents: a Common Experience Pain 87(2000) 51-58
2. Blyth et Al 2001. NSW Health Survey based on International Association for the Study of Pain ( IASP criteria);
3. National Pain Strategy 2010 – Pain in Children p 17.
4.Varni 2007; Vetter 2008
5. Wolfe et al 2000
Background Notes:
Effective application of the WHO Guidelines will bring about a number of Important changes to the way that pain in children is understood, recognised and managed, for example:
- Provide knowledge and guidance to ensure doctors have the confidence to treat children with appropriate levels of care and medication, which will avoid current high levels of under-treatment.
- Create awareness of the way that children experience pain, including neonates, and the potential long term impact of this on their quality of life and future response to pain.
- Encourage greater awareness of the impact on tiny children of invasive procedures ( eg heel lances, needles, various intensive care practices, circumcision etc ) - so that greater care is taken to avoid or minimise the associated pain and trauma..
- Ensure policy makers and service providers are aware of the importance of child-friendly facilities, and the need for appropriate care that prevents transition to chronic pain and illnesses in adulthood, and its associated costs to the health system.
- Help destigmatise the plight of children who live with chronic pain so that their families, school mates and others are more understanding and do not dismiss their pain as a sign of weakness or inability to cope.
- Assist children to better manage pain, so that it does not interfere with school work, play, sport and other things that healthy kids enjoy.
- Encourage the development of more dedicated facilities for treating children in appropriate environments where they are not exposed to the often frightening experiences at pain centres where they may be treated alongside adults with severe disabilities, terrible burns and other traumatic conditions.
Educational Initiatives to Support the WHO Guidelines
Undergraduate Education:
The new Discipline of Pain Medicine at the University of Sydney is now enrolling students from medical and health sciences faculties and the curriculum includes a focus on paediatric pain management, including reference to the WHO Guidelines.
The Multidisciplinary Pain Symposium to be held regularly at Sydney University will include a component on Paediatric Pain Management and the Guidelines.
Painaustralia plans to develop an online module based on the Pain Symposium Curriculum to be available for undergraduates from other campuses.
Online Post Graduate Education for Primary Care Professionals:
A new online pain education program for primary health care professionals, developed jointly by the Australian and New Zealand College of Anaesthetists, Faculty of Pain Medicine and the Royal Australian College of GP's with funding from Bupa Australia Foundation, will be launched later this year.
The module will be promoted by Painaustralia with reference to the WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children with Medical Illnesses.
The Guidelines will be promoted in Painaustralia's web-based Register of Educational Resources and Clinical Guidelines on Vest Practice Pain Management for health care professionals.
The Children's Hospital Westmead will be promoting the WHO Guidelines and its Annual Pain and Palliative Care Symposium on 7-8th March 2013.
WHO Guidelines and Brochures
Veteran's Magazine - Men's Health Peer Education
View the March 2012 edition of Men's Health Peer Education dedicated to Pain Management. Articles include:
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Inaugural Pain Management Symposium
Join experts from the Discipline of Pain Medicine to learn about the treatment of pain.
The Inaugural Pain Management Symposium will be held Friday 16 March and Saturday 17 March 2012.
Chronic pain is Australia's third most costly health problem, and is largely poorly treated and misunderstood.
One in five Australians live with chronic pain, yet up to 80 percent of them are missing out on treatment that could improve their health and quality of life.
The Pain Management Symposium is open to all USyd students studying health related disciplines, in order to learn about the treatment of pain.
Topics will include acute, chronic, paediatric, cancer and oro-facial pain.
For more information and bookings:
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Phone: 02 9926 7386
Download the flyer
Download the media release
Pelvic Pain Report
The $6 Billion Woman and the $600 Million Girl, a landmark report into one of Australia's most common medical conditions, has been launched by Painaustralia and the Pelvic Pain Steering Committee to help improve the quality of life of more than 1.2 million women and girls.
To read the full report, click here
To download the media kit, click here
Pelvic Pain Media
- Interview with Dr Susan Evans, Dr John Darcy Health Matters 4 March 2012
- New Report Reveals Medical Worries, Radio Adelaide Breakfast with Tim Brunero 30 November 2011
- Suffering in Silence with Pelvic Pain, The Advertiser, 29 November 2011
- Pelvic pain in women and girls often goes misdiagnosed, ABC Radio National, Breakfast with Fran Kelly, 28 November 2011
- Women Must Speak Up About Pain, TopNews, US, 28 November 2011
- Women's Pelvic Pain: Is It There 'Last Taboo'?, TopNews NZ, 28 November 2011
- Pelvic Pain in Women Trivialised. National Nine News, 27 November 2011
- Women's pelvic pain is one of the 'last taboos', Canberra Times, 27 November 2011
- Pelvic Pain In Women Trivialised, Australian News, 27 November 2011
Global Year Against Headache Launched - October 2011
The Global Year Against Headache was launched on Monday 17th October 2011. Pain medicine physicians are targeting the milions of Australian's who suffer from migraines and other headaches, costing the communities more than $1 billion each year. The Global Year Against Headache is an initiative of the International Association for the Study of Pain (IASP).
Read the press release.
Download the IASP factsheets:
- Vascular Changes in Headache
- Genetics in Headache
- Headache in Childhood & Adolescence
- Medication Overuse Headache
- Migraine
- Migraine & Hormonal Changes
- Neurophysiology
- Neuroimaging in Headache
- Neuromodulation in Primary Headaches
- Rigemino-Autonomic Headaches
- Short Stabbing Headaches
- Tension Type Headache
- Trigeminal Neuralgia and Persistent Idiopathic Facial Pain