Today, millions of Australians will visit their local GP or other health professional to seek help for one very common condition; pain. Pain is the one complicated thread that links nearly every ailment and malady our medical system can treat. And that is just the start of the problem.
For many years we have grappled with the complexities of chronic pain. Sometimes pain cannot be ‘treated’, cannot be explained, cannot be ‘killed’ with medication. Effective pain management, the way we respond to chronic and persistent pain, has now become one of those glaring public health challenges. Like pain itself, this challenge is often overlooked or invisible to the public eye.
A new report has shone a light on the true magnitude of the issue. We now know that over 3.2 million Australians live with painful conditions, from arthritis to low back pain, to endometriosis and fibromyalgia. Across all these chronic conditions sit a labyrinth of treatment pathways. Sometimes these pathways manage to get people headed in the right direction, but more often they lead to further problems and ongoing suffering.
New data by Deloitte Access Economics shows that more than 68% of pain management consultations will end with a GP prescribing pain medication. Another 13% will end in imaging, but less than 15% can hope to be referred to an allied health professional.
This is situation that is problematic on two fronts. Not only are we pushing millions of Australians towards a pharmacological pathway of pain management, we are also depriving them of what is an evidence-based way of best practice pain management.
The first of these issues, the over-reliance on pain medication now has a name: The Opioid Crisis. This epidemic is expanding on a global scale. In Australia, the rise in prescribing of pain medications, particularly opioids, has had devastating results, with the levels of harm and deaths due to opioid misuse rising exponentially.
Over three million people were prescribed 15.4 million opioid scripts in 2016–17. Most concerningly, opioids now account for 62% of drug-induced deaths, with pharmaceutical opioids now more likely than heroin to be involved in opioid deaths and hospitalisations. In 2016–17 there were 5,112 emergency department presentations and 9,636 hospitalisations due to opioid poisoning, with three deaths per day attributed to opioid harm - higher than the road toll.
While these numbers may seem enormous, of even more concern are the very real struggles faced by the people behind these figures. Every day millions of Australians battle with the physical, mental and emotional toll of chronic pain impacting every facet of their lives. Nearly 1.45 million people in pain also live with depression and anxiety.
Unfortunately, a lack of pain specialist care and GPs with limited options to deal with chronic pain, means many of these Australians are falling through the cracks of the country’s health system. They are not receiving the multidisciplinary care they deserve and are inappropriately prescribed opioids which is not recommended for the ongoing treatment of chronic pain.
This has led to some truly staggering economic costs. Chronic pain now costs Australia 73.2 billion dollars each year including $48.3 billion in lost productivity; and even larger is the impact on quality of life – costing our society an estimated $66.1 billion each and every year and bringing the total cost to $139.3 billion.
The stakes are clearly very high. If our policy framework to treat pain doesn’t change, then the annual cost of pain in Australia will rise from $139.3 billion in 2018 to an estimated $215.6 billion by 2050.
This seems like an insurmountable challenge. Where do we begin to start unravelling an issue so complex, and so entrenched across the spectrum of our health, social and economic structures?
As always, the answer often lies at the heart of the issue, the person living with chronic pain. We must go back to basics and provide consumers with the support they need to make informed decisions around their pain management options and pathways. We need to educate both consumers and health practitioners that chronic pain is not just a physical condition or a symptom, but a chronic condition in its own right.
This approach to pain management, the psycho-social-bio approach, is central to the aims of both the National Pain Strategy and the National Strategic Action Plan for Pain Management. Both these visionary documents provide a blueprint for the treatment of pain, recommending an interdisciplinary approach to deliver best practice pain management which takes into account the complex physical, psychological and environmental factors that underpin pain conditions.
We have extensive evidence to show the impact of poor pain management. It is clear too many people are suffering, too many have waited for too long to get the help they need.
We now have a responsibility to these people to move beyond all the statistics, all the words, all the policy documents and their well-meaning sentiments. We have the solutions clearly outlined in an agreed National Action Plan. Failing to address chronic pain in Australia is no longer an option.
Carol Bennett, CEO
 Deloitte Access Economics (2019), The cost of pain in Australia. Access online here.
 Australian Institute of Health and Welfare 2018. Opioid harm in Australia and comparisons between Australia and Canada. Cat. no. HSE 210. Canberra: AIHW
 Royal Australian College of General Practitioners (2018). Australian overdose deaths are increasing – and the demographics are changing. News GP. Access online here.