TREATMENTS

In May 2018, the Australian Government announced support for the development of the first ever National Strategic Action Plan for Pain Management
(the Action Plan). The Action Plan sets out the key priority actions to improve access to, and knowledge of best practice pain management.

Acupuncture & Chinese medicine, along with other Allied health professions sit within this framework. It’s important to recognise that pain management strategies, especially in dealing with chronic pain, need to be comprehensive and open to a multi disciplinary approach to achieve lasting positive outcomes. As much as any one strategy has it’s strengths it is by working together that a real impact can be made and real lives can be bettered and improved.

The following is both a summary and overview of some of the key points of the plan. A reference to the full plan can be found in the resources page.

Identifying different types of pain:

Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain and can be caused by a range of conditions or factors including injury, surgery, arthritis, osteoporosis or musculoskeletal conditions.

Neuropathic pain is a type of pain that occurs following damage to the nervous system itself. The sensations associated with this type of pain are described as burning or shooting pains. The skin can be numb, tingling or extremely sensitive.

Nociplastic pain is essentially pain related to increased nervous system sensitisation rather than tissue or nerve injury despite no clear evidence of actual or threatened tissue damage.

Five categories of pain (National Pain Strategy): 

1. Acute pain, defined as a normal and time-limited response to trauma or other ‘noxious’ experience, including pain related to medical procedures and acute medical conditions. Acute pain can also arise from physiological causes such as childbirth. If poorly managed, it can lead to more serious health issues, including chronic pain.

 2. Pain that is progressing towards chronic pain, but this progression may be prevented (‘subacute’ pain). For example, acute wound pain may progress to chronic wound-associated pain.

3. Recurrent pain, e.g. migraine

4. Chronic (or persistent) non-cancer pain that persists for longer than 3 months

5. Cancer-related pain

Millions of Australians live with pain

• One in five Australian adults are estimated to live with chronic pain (daily pain for more than three months, experienced in the last three months).
• Chronic pain is even more common among Australians aged over 65, with one in three living with chronic pain. Up to 80 percent of residents of aged cared facilities are living with persistent pain, which is often under-treated or poorly managed.
• Between 25 to 35% of children and adolescents experience chronic pain.
• The pain burden is growing. The Cost of Pain report has pulled data out of the health, aging and disability sectors, to reveal the staggering cost of chronic pain to taxpayers. In 2018, this figure was $139.3 billion. This was on top of the fact that Australians paid $2.7 billion in out-of-pocket expenses to manage their pain, with costs to the health system in excess of $12 billion.

Pain is closely associated with other health conditions, mental health and disability

• Comorbidity (the occurrence of two or more diseases in a person at one time) is very common among people living with pain conditions like arthritis and back pain.
• Chronic pain and mental health problems, particularly depression, commonly occur together.
• Major depression in patients with chronic pain is associated with reduced functioning, poorer treatment response and increased health care costs. High rates of generalised anxiety disorder, post traumatic stress disorder and substance misuse are also reported in people with chronic pain. Moreover, suicide is reported to be two to three times higher in those suffering chronic pain compared to the general population, and it is associated with depression.This may be due to opioid related deaths, but there is a lack of research in this area.
• In 2018 the top three chronic disease combinations were: depression or anxiety (44.6%), osteoarthritis and degenerative arthritis (29.3%) and high blood pressure (25.1%).
• Chronic pain and mental health problems, particularly depression, commonly occur together. In Australia and New Zealand, 40.5% of pain patients captured in ePPOC data in 2016 reported also suffering depression and/or anxiety.
• For those who experience chronic pain, the pain can be debilitating and have an adverse effect on work, sleep, and relationships. Individuals with chronic pain may also commonly experience comorbidities such as depression, sleep disturbance and fatigue.
• These comorbidities often contribute to worse health, societal and financial outcomes — for example, major depression in patients with chronic pain is associated with reduced functioning, poorer treatment response, and increased health care costs.

Chronic pain is a leading cause of economic and social exclusion

• Pain deeply impacts on people’s ability to participate in work, education or the community. Globally, the median period that a person lives with chronic pain is seven years.
• Back pain and arthritis are two of the most common health conditions that cause premature retirement for people between the ages of 45 and 64, accounting for about 40% of cases.
• The daily challenges of chronic pain include decreased enjoyment of normal activities, loss of function and relationship difficulties.
• As chronic pain is largely invisible, those living with pain report feeling stigmatised by co-workers, friends, family, and the medical profession.

          People can’t access pain services

• Up to 80% of people living with chronic pain are missing out on treatment that could improve their health, quality of life and workforce participation including access to pain specialists and one-stop pain clinics that offer interdisciplinary care, but also services at the primary care level.
• 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.

There is low awareness of pain and its treatment options

• Awareness of pain and pain management is also low among health practitioners and consumers. For example, clinicians’ beliefs and practice behaviours relating to lower back pain were found to be discordant with contemporary evidence on the most effective treatments.
• Challenging beliefs about pain and its treatment is critical to build resilience in consumers and producing more effective health outcomes. Explaining the neuroscience of pain has been shown to improve pain and movement, and reduce fear avoidance.
• Over the last 20 years between 1996 and 2016, research aimed at understanding pain has attracted $133 million. In comparison, between 2012 and 2017, cardiovascular disease has received $687 million of research funding.

The Plan has set out 8 key goals that need to be achieved to improve the landscape and future of pain management

GOAL 1:

People living with pain are recognised as a national and public health priority

GOAL 2:

Consumers, their carers and the wider community are more empowered knowledgeable and supported to understand and manage pain

GOAL 3:

Health practitioners are well-informed and skilled on best practice evidence-based care and are supported to deliver this care

GOAL 4:

People living with pain have timely access to consumer-centred best practice pain management including self-management, early intervention strategies and interdisciplinary care and support

GOAL 5:

Outcomes in pain management are improved and evaluated on an ongoing basis to ensure consumer-centred pain services are provided that are best practice and keep pace with innovation

GOAL 6:

Knowledge of pain flourishes and is communicated to health practitioners and consumers through a national research strategy

GOAL 7:

Chronic pain is minimised through prevention and early intervention strategies

GOAL 8:

People living with pain are supported to participate in work and community