Living with chronic pain can take a physical, emotional and mental toll. It can result in being unable to study, work or maintain relationships. It can limit the extent to which a person participates in daily activities. Chronic pain can isolate you, reduce your quality of life and wear you down. Now, replace ‘chronic pain’ with ‘mental health’ and the paragraph above would still be accurate.
While overall awareness of mental health and responses to it have improved over recent years, the same can’t be said for chronic pain which remains a largely invisible condition.
The Australian Bureau of Statistics has found that one in five Australian adults with severe or very severe pain also suffer from depression or other mood disorders – four times the rate for people without pain – and one in three have high levels of psychological distress. The Cost of Pain in Australia Report found that 44% of people living with chronic pain also live with depression and anxiety. Suicidal ideation is about 3-4 times higher among people living with chronic pain and have been implicated in 21% of suicides in this country.
The link and parallels between chronic pain and mental health are well known and clearly established. For some, the root cause or significant contributing factor to mental health problems is chronic pain. Yet people living with chronic pain seem largely invisible within existing mental health services.
The landmark final report from the Royal Commission into the Victorian Mental Health System was released on 2 March 2021. Find it here. You would think that the report – being hundreds of pages long with the executive summary alone being 120 pages – would highlight this link. You would expect that a few recommendations would be about addressing chronic pain as a significant factor leading to poor mental health. However, a search for the word ‘pain’ in the executive summary yields only one result while the recommendations do not mention the word ‘pain’ at all.
Painaustralia’s submission to the Commission’s review (one of many on this issue) called for:
design and service delivery addressing key access issues consider the nexus between mental health and pain conditions to ensure early intervention and improve long term outcomes
That a biopsychosocial model using best practice pain management is adapted to capture the overlap in the treatment pathways of those with mental health and chronic pain conditions
That Victorian mental health policies make reference to and adapt resources for addressing both chronic pain and mental health comorbidities
That mental health policies specifically reference the National Pain Strategy
The adoption of the new Strategic Action Plan for Pain Management should be a priority for consideration by the Council of Australian Government’s and the Australian Health Minister’s Advisory Council
The development of consumer and health professional awareness programs that highlight the interrelationship between mental health and chronic pain.
Similarly, Painaustralia’s 2020-21 Budget Submission calls for MBS items to support multidisciplinary and mental health care for people living with chronic pain. A new MBS item, or items, to support the planning and review of multidisciplinary pain management will not only lead to better health outcomes for people living with chronic pain, but it will also reduce the use of hospital-based services and over-reliance on medication including opioids.
Prevention is better than cure. We need a multidisciplinary approach to addressing chronic pain not just because that is best practice and will improve many lives, but also because it will reduce the burden of mental illness.
Unfortunately, many of the currently available and accessible treatment options for people experiencing chronic pain could be described as an ad hoc collection of sub‑optimal band aid solutions.
We need to lift the invisibility cloak off people living with chronic pain not just so we can see and address their issues, but also because it will make a huge difference to Australia’s provision of other services, especially our mental health service. Focusing on mental health and not talking about pain makes no sense at all.