“I always thought I was going to get better, and I think a lot of people do when they get chronic pain. You never think it’s the end of the road; you always think that you get sick and you get better, you go to hospital and you do this and you get better.”
Sister Mary-Lynne Cochrane is the Chair of Painaustralia’s Consumer Advisory Group. Since her early 20s, not long after she was professed as a Good Samaritan Sister, Mary-Lynne has lived with a rare form of arthritis that has led to over 20 surgeries – including three back surgeries, a bone transplant, and the replacement of nearly all her major joints – and constant, debilitating pain.
And for a long period, she relied on pain medications to manage her chronic pain. Mary-Lynne admits that chronic pain and the side-effects of heavy prescription opioids took a massive toll on her life.
Just like Mary-Lynne, millions of people around Australia struggle with the challenges of managing their chronic pain. A lot of them, like Mary-Lynne, have had surgeries in the hope of addressing the problem. Others have had pain medications prescribed to them as a result of surgery to manage post-surgical and acute pain.
So what happens when these people get back home and find weeks later that the pain continues and may actually get worse? This is a tricky time for most people to navigate. There is a tremendous lack of awareness around what you should do in these situations, and a lot of people end up seeking more pain medication, unaware that they will likely be unhelpful in the long-term management of pain, and may make the pain worse.
In the hype and hysteria surrounding opioid regulatory changes, we seem to have lost sight of the fact that a lot of people initially start using them as a result of acute, post-surgical pain management without good follow-up and support to taper use. When you consider the fact that in 2017-18, 1 in 4 hospitalisations involved surgery (2.7 million), you can see why this is a crucial issue. The dose and quantities of opioids prescribed at discharge have been identified as a risk factor for long-term use. The Society of Hospital Pharmacists (SHPA) Reducing opioid-related harm report revealed opioid de-escalation plans at hospital discharge are rare and supplying opioids for patients to take home “just in case” is still common practice.
Post-surgery is a critical juncture to prevent chronic pain by providing information and support to people as identified by a number of key groups such as the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists recommended in the National Strategic Action Plan for Pain Management. It is at this point that people who are at a risk can be offered preventative options to decrease the likelihood of escalating chronic pain. This requires best practice post injury, operation or illness pain assessment, support and management, as well as appropriate diagnostic and treatment strategies to prevent the transition from acute to chronic pain.
This week, Painaustralia has welcomed the launch of a new resource, Managing pain and opioid medicines, that is a much-needed missing piece of this puzzle. This excellent two-page patient guide, developed by NPS MedicineWise Choosing Wisely Australia initiative, will be provided to people prescribed opioids as inpatients, or on discharge to raise awareness about opioids use for short-term pain, their side effects and the risks of dependence.
SHPA Chief Executive Kristin Michaels strongly supported the new resources said there is an important need for patient-centred tools for self-assessment and management of pain and the need for consumer health organisations to educate patients regarding managing pain expectations.
Just after her third major back surgery (an exceptionally traumatic experience when her pain levels could not be contained) Mary-Lynne Cochrane was encouraged to visit a pain clinic. She participated in a six-week program which introduced her to a multidisciplinary approach to pain management that included support from pain physicians, physiotherapists, psychologists and nutritionists. She is well on the path to self-managing her pain now and understands the importance of prevention and early intervention.
She wishes that such resources had been around thirty years ago, when she first started on the long road to seek pain management.