People with chronic pain missing out on vital care

The 2024 National Pain Report highlighted how pain colours the world of not just those living with chronic pain but society as a whole.

In particular, the report found that:

• 1 in 2 people with chronic pain have had to stop working;
• 45% of people with chronic pain took longer than 3 years to get a diagnosis;
• 1 in 2 women with chronic pain experienced medical misogyny;
• 9 in 10 young people living with pain have been ignored or dismissed by health professionals.

The most common types of pain are back pain (17.4%), widespread pain (eg, fibromyalgia; 22.9%), and nerve pain (eg, neuralgia; 10.4%) with men more likely to experience back pain and women more likely to experience widespread pain.

Finding out the reason for the pain can be a challenge, with 45% of respondents saying it took longer than three years to get a diagnosis and 11% of respondents still undiagnosed.

The challenge of accessing care

Even when a person has a diagnosis, it’s difficult to get the care they need. According to Chronic Pain Australia chairperson Nicolette Ellis, treating chronic pain needs a biological, psychological and social approach.

“We have to treat the entire individual because chronic pain colours every aspect of that individual’s life,” she told InSight+.

Multidisciplinary care is recognised as the gold standard in chronic pain management; however, most people can only get this through hospital-based programs, which are difficult to access. Not only are they generally based in metropolitan areas, but they’ve also got long wait times.

“On average, it’s at best six months to one year, and at worst we’re seeing two to three years. Only one in 100 people with chronic pain are getting access to these multidisciplinary pain management programs,” Ms Ellis said.

Treating chronic pain in primary care

The survey noted that GPs are the most trusted and most knowledgeable health professional for chronic pain.

“I think it’s really important that we note that patients are really looking to their GP as their main navigator and main supporter in managing the chronic pain conditions,” Ms Ellis said.

Which is why she said introducing multidisciplinary pain programs into primary care makes sense.

“From Chronic Pain Australia’s perspective, there’s no reason why category three patients should be referred into hospital pain clinics. They should be able to be really well managed in primary care settings, as long as the GP has access to a multidisciplinary pain management program and a team that can wrap around them and their patients and help support them in their primary care setting,” she said.

It was this philosophy that led to a community-based multidisciplinary care program being developed in the Brisbane North Primary Health Network (PHN). The program was developed by the Health Alliance, a collaboration between Metro North Health and Brisbane North PHN.

Health Alliance general manager Ian Purcell explained that they had a huge wait list of up to 500 days for people to access tertiary pain management treatments. In addition, many people would have to travel up to 50 km to access that tertiary service.

“So what we were looking to do was to set something up which is community-based, that was based on a similar model to the service they would be receiving from the tertiary clinic, which was really a multidisciplinary care approach for those patients, with group work, individual work, and allied health treatments as well,” he said.

People now wait up to 21 days to access the program, which runs for around six months. It’s made up of education sessions and allied health appointments.

“Through the community provider, they do patient experience measures, and we’ve got very high satisfaction with the service. Up to 95% of patients on the program are satisfied with that experience,” he said.

The goal of the program is self-management.

“Often times what we have seen… is that people are either coming off medication or changing medications that they’re on, and they feel more empowered to manage the condition themselves and they know about support that’s around in the community for them when they need it.”

Ms Ellis agreed that patient agency is particularly important when it comes to managing medication. The National Pain Survey highlighted that since the move to reduce opioid prescriptions, one in five respondents have been forced to reduce their opioids, with no choice offered.

“Reducing someone’s opioids without consent… can be a significant harm to that person. In the research, (which is really important for doctors to be aware of) if a patient hasn’t consented to reducing their opioids, they’re three times more likely to be at harm of opioid toxicity or an opioid overdose.

“Put the patient in the driver’s seat because their patient agency will make it so much more effective for them, and they’ll likely not end up in pain consequence, or mental health distress in those scenarios,” she said.

Pain management education

One of the goals for both the Brisbane Health Alliance’s pain program and Chronic Pain Australia is providing education and strategies for health care professionals who are caring for patients in pain.

“We’ve established case conferencing between treatment teams in the tertiary facility as well as the Allied Health team, so they can share information and learnings with each other and about the patient cohort that they’re really interested in,” Mr Purcell explained.

Ms Ellis also highlighted resources and training offered by Chronic Pain Australia with the aim to reduce low value care, which includes opioid, MRI and CT scans. She highlighted a fact sheet on opioid tapering and a webinar on this year’s National Pain Week page, which goes through surgeries, devices and chronic pain.

“Dr Dilip Kapur who is the Dean of the Faculty of Pain Medicine talks about going through a pain assessment with a patient and how 70% of that should be around a really good understanding of the patient’s history from that biological, psychological and social approach and goal setting. And then maybe 20% is the physical examination,” she explained.

Chronic Paint Australia are also launching a standardised pain management education program later in the year that will be targeted towards GPs.

“We really need to upskill ourselves in that neuroscience approach around why chronic pain persists. That would be a key thing to avoid those low value health care items. And to really work through that biological, psychological and social approach in your pain assessment with a patient is a good start,” Ms Ellis said.

The most important thing is to build a therapeutic relationship with the patient to help them manage their condition.

“It might be that you maintain the opioids for a period of time to build that trust and rapport and that therapeutic relationship, until you approach re-challenging or changing therapies and work on other things for their pain management together. It can be a challenging place to work in,” Ms Ellis concluded.