A new plan for pain

stressed looking woman a desk

Painaustralia has launched its National Strategic Action Plan for Pain Management, highlighting that chronic pain can significantly impact individuals and their networks

Millions of Australians live with ongoing persistent pain, says the group, which can have  a “devastating” impact on individuals, their families, workplaces and the community.

Such pain often contributes to problems including opioid dependency, depression, loss of income and increased risk of suicide, the organisation says.

“The Australian Government and Minister Greg Hunt funded and supported the development of the first ever National Strategic Action Plan for Pain Management (NSAPPM) in May 2018,” Painaustralia CEO Carol Bennett said.

“The year of exhaustive consultation and development that followed have now culminated with the final release of the NSAPPM that sets out the key priority actions to improve access to, and knowledge of best practice pain management, in the next three years.”

According to Painaustralia the NSAPPM comes at a critical time when pain management is at the intersection of key global public health challenges of the 21st century, including the safe and effective use of medications (particularly opioids) and the urgent need to stem the rise of chronic conditions.

Consultations with the pain management sector and stakeholders have confirmed the need for greater awareness of pain and pain management, more timely access to consumer-centred interdisciplinary services and research to underpin greater knowledge of pain, it says.

It says the NSAPPM builds on the strong foundation and advocacy of Australia’s pain sector which developed the first National Pain Strategy in 2010 to provide a blueprint for best practice pain management.

“This Action Plan provides us with a clear pathway to meet the challenges that chronic pain poses to all Australians,” says Ms Bennett.

“The Deloitte Access Economics Cost of Pain report released by Minister Hunt in April this year has highlighted the seriousness of the pain burden in Australia and makes a clear case for investment and support to prevent and manage chronic pain conditions.”

The number of Australians living with chronic pain is set to rise from 3.24 million to 5.23 million by 2050, the organisation warns, saying that inaction will see the chronic pain price tag remain in the $billions.

Last year alone, Australians paid $2.7 billion in out of pocket expenses to manage their pain, it says. As a nation, the annual cost will rise from $139.3 billion in 2018 to an estimated $215.6 billion by 2050. 

“The Australian Government and Minister Hunt have demonstrated their commitment to addressing chronic pain, with an election commitment of $6.8m to deliver better pain management across Australia, as well as the establishment of a National Advisory Council on Pain,” Ms Bennett said.

The NSAPPM will now progress to the Australian Health Ministers Council, ahead of being presented to the Council of Australian Government’s for endorsement in the coming weeks.   

 “Australia now has the opportunity to lead the world with the implementation of the first, fully funded government response to comprehensively addressing the burden of pain,” says Ms Bennett.

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  1. Debbie Rigby

    The National Strategic Action Plan for Pain Management has important implications and opportunities for pharmacists. With 1 in 5 Australians experiencing chronic pain (1 in 3 older people), pharmacists can play a key role in improving pain management, in community and hospital pharmacies, with HMRs and RMMRs, and for pharmacists in general practice. We often see people with chronic low back pain and other MSK issues, as well as migraine and headache. And are well aware of comorbid mental health problems.

    Evidence strongly suggests an over-reliance on medications, and associated problems with abuse, misuse and poor patient outcomes. The recent up-scheduling of codeine, together with alarming figures on inappropriate opioid use have highlighted how far we are from best practice care of chronic pain.

    There is some great CPD available for us to upskill our knowledge and skills. Reading the Action Plan should prompt reflection on our own beliefs and attitude towards chronic pain management. I think the Chronic Pain MedsCheck trial is a good step towards patient-centred multidisciplinary care for pharmacists in the community.

    One of the key goals of the Action Plan states: “The reliance on prescribing pain medications for chronic pain is minimised.” To change this, I think pharmacists need to shift our conversations with people living with chronic pain towards the sociopsychobiomedical model, integrate concepts of patient activation and validation in our patient conversations, and identify elements of pain catastrophising. It’s always important to acknowledge the patient’s lived experience; but equally important to shift that reliance on medications towards more effective strategies.

    It’s a great opportunity for pharmacists to be part of the solution.

    The document is available at https://www.painaustralia.org.au/static/uploads/files/national-action-plan-final-19-06-2019-wfvkmwihfzxv.pdf

    The Brainman video is a great start to understand chronic pain – https://www.youtube.com/watch?v=5KrUL8tOaQs

    • Jarrod McMaugh

      Some consideration needs to be given to the language used.

      “Catastrophising” undermines the experiences of a person who has pain.

      Their experiences are their experiences, & health care providers need to be extremely careful not to imply or suggest that a person’s experiences of pain aren’t legitimate.

      Disclosure: I am president of Chronic Pain Australia.

      • Debbie Rigby

        I am always very mindful of language. The term pain catastrophising is well described.

        Pain catastrophising has been described as an exaggerated negative mental set brought to bear during actual or anticipated painful experience. It is one of the most potent predictors of pain-related outcomes. these unhelpful dominating thoughts and negative beliefs play an important role in the maintenance and exacerbation of chronic pain. Pain catastrophising is associated with greater functional impairment, pain intensity, depression, anxiety, work absenteeism, opioid misuse and healthcare utilisation. So pharmacists do need to be mindful of this when talking to people living with chronic pain.

        One proven way to combat pain catastrophizing is to recognize it. During our conversation with patients we can listen for language which indicates negative thoughts and feelings e.g. “It’s awful and I feel that it overwhelms me” (helplessness);”I keep thinking about how much it hurts (rumination); “I’m afraid that the pain will get worse” (magnification). Helplessness or low self-efficacy correlates with level of disability among patients with chronic low back pain. Magnification is related HRQoL and functioning. Both helplessness and magnification are related to mental health QoL and depression.

        So, to my point, I think Pharmacists have a vital role to play in caring for people living with chronic pain. And we need to understand the underpinning psychosocial concepts. Validation is extremely important – showing the patient that their thoughts and feeling are understandable and legitimate is much more effective than reassurance. Acknowledging the person’s experiences validates their experiences of living with chronic pain and communicates empathy, acceptance and understanding without judgment. It helps set the stage for further engagement and behavioural change. As the Action Plan states, we need to reduce the reliance on medicines.

        • Jarrod McMaugh

          The issue still remains that the term “catastrophising” is not patient-centred (in fact, it is very far from it).

          The language we use to talk **about** people is as important as the language we use when talking to people.

          In fact, you’re response highlights the issue:
          “During our conversation with patients we can listen for language ….”
          People in pain (or who have any other health condition) also listen for language, and it causes as much harm as any other barrier to appropriate treatment.

          In the 2018 Pain Survey, communication with health professionals was cited as a major barrier to accessing health care. Disempowering terminology is a major factor in this. People want to be treated as and thought of as equals in their healthcare. How we as health professionals talk about people matters.

  2. neen

    Debbie everyone keeps pointing to studies that show that opioids are not effective for chronic pain, opioids can increase pain, opioids prescribed for chronic pain leads to addiction and maladaptive behaviours…on and on. Yet no one will actually post a LINK to these studies. Perhaps you can? BEcause I can’t find these studies.
    Another thought…if I, as a chronic pain patient have been utilising psychological care including CBT and ACT, acupuncture, physiotherapy, appropriate exercise, eat a healthy diet and maintain a healthy bodyweight, maintain social relationships and a positive attitude, and after all that, I still need opioids to manage my pain, you can be assured that I have spoken to no less than TEN experts, all of whom have made me jump through multiple hoops before deciding that they can’t help me further, last of all a pain management doctor with many years of experience and education, and they will have ALL talked me through the bio-psyco-social model of pain. The very LAST thing in the world I want is my pharmacist to QUESTION my prescription. That is NOT your role. I doubt you’re aware of how hard it actually is to get ongoing opioid scripts for chronic pain not responsive to other analgesia. It’s hard work, and having a pharmacist question the script or run me through their version of meds check is the very last thing I want or need. Further, chronic pain being a complex interplay of factors, its unlikely you’ll EVER know or understand a patient well enough to add value or anything that all of the previous practitioners haven’t already covered. So please, provide those studies that back up your position and reasoning.

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