It is well known that people in rural, regional and remote Australia experience worse health outcomes than their city counterparts. They have less access to services and are exposed to increased health risks. This setting could not be truer when it comes to chronic pain, with both prevention and management resources severely lacking.
People who live outside urban areas are 23% more likely to experience back pain, with higher percentages in the 55 to 64 age group. People living regionally are also 30% more likely to have a long-term health condition due to an injury.
A recent Painaustralia submission to the Federal Government noted pain is the leading cause of early retirement (40%) and is strongly associated with markers of social disadvantage. This is acutely felt in rural and remote communities where job opportunities are limited, and regions may face economic decline.
There are many factors behind these statistics, including the location of physically demanding jobs in industries such as agriculture, fisheries, forestry and mining in these areas.
Despite the likelihood of people in these areas needing the best-practice pain management, arguably more so than their urban counterparts, access to these services is woefully absent with a lack of specialists and allied health professionals and GP’s professional training in pain management inadequate.
Most public and private pain clinics that offer interdisciplinary care in one physical location are predominately located in the major capital cities. Specialist Pain Medicine Physicians (SPMPs) are concentrated in the major cities of NSW, South Australia, Victoria, Western Australia and Queensland. There is no pain specialist in the NT.
There are only seven paediatric pain clinics in Australia, with none in Tasmania, the ACT or the NT. The physiotherapy workforce, integral to interdisciplinary pain management, is also not evenly distributed and there is a shortage in rural and remote areas. Meanwhile, allied health services are extremely limited in rural and regional Australia making access to best practice pain management almost impossible.
The consequences of these gaps are immense, while the price paid by people with chronic pain is continued physical and psychological ill health, social exclusion and financial disadvantage.
Without adequate pain management available in rural and remote areas there is a greater reliance on pain medications to treat chronic pain despite limited evidence of their efficacy for that purpose or safety. This has led to a 30 per cent increase in opioid prescribing between 2009 and 2014 and opioid overdoses including accidental overdoses at record levels in Australia.
Consumption of prescription opioids in regional areas was much greater than in capital cities as found in a 2017 analysis of 54 wastewater sites by the Australian Criminal Intelligence Commission. Consumption of powerful opioids oxycodone and fentanyl in regional sites was well above capital city levels, with the average use of oxycodone in regional areas almost double that in capital cities.
The Australian Commission on Safety and Quality in Health Care revealed opioid medications were being prescribed in some regional areas at 10 times the rate of other areas and they recommend proactive action on pain and opioid management in rural areas.
Australia is in an epidemic of prescribed opioid misuse, yet this issue has barely made it onto the public agenda. It is indisputable that nearly all opioid prescribing has its origins in efforts to manage acute or chronic pain, yet the public discussion about how we could manage pain better and more safely is still focussed on drug addiction and dependency.
We must do better.
Thankfully, there are proven ways to improve this grim situation now as well as larger reforms that will make an even greater difference in years to come.
In rural and regional Australia, moving towards best-practice pain management includes actions like putting in place proven good quality ‘mini pain programs’ to provide coordinated care packages and increase the capacity of health practitioners. There are excellent existing models including the Pain Revolution Local Pain Educator (LPE) program and other models in South Australia and Western Australia that embed capacity in regional and rural communities in pain management and education.
There are also good models of practice in Primary Health Networks (PHNs) involving expert education programs and individual case management. Broadening capacity within existing primary and community health services in general pain management services is a cost-effective way of addressing the issues. Expanded telehealth programs to provide access to specialist pain services in regional areas is also commendable.
Poor access to pain management services delay treatment, increase levels of disability and reduce capacity to return-to-work while impacting quality of life. This has an enormous impact on the health and wellbeing of our rural and regional communities.
It is arguable that the need for action is higher in our non-metropolitan areas given the issues outlined above. If we can address the impact of pain in regional Australia, we will go a long way towards improving the health of communities in general given how intertwined chronic pain is with other chronic health and mental health conditions.
Carol Bennett, CEO
*The 15th National Rural Health Alliance Conference is being held 24-27 March 2019 in Hobart and will address this issue in a presentation by Carol Bennett on Monday 25 March 2019. View the abstract here or see the full paper here.