From opioid crisis to chronic pain epidemic
Chronic pain is a complex health condition and unfortunately there is no cure for most cases. But there is good evidence that people can live fulfilling and happy lives despite their pain with multidisciplinary pain management. This involves regular exercise and physiotherapy, nutrition planning, pain education and the use of cognitive and behavioural strategies to help people to cope with pain “flare ups”. However, there are not enough multidisciplinary pain clinics to even scratch the surface of demand. Some have waitlists of up to three years to see new patients. The situation is particularly bad in regional and rural areas, where specialist services are very limited or non-existent.
Because of the scarcity of funding for multidisciplinary pain services in Australia, 99 per cent of patients with chronic pain never step foot in a pain clinic. Rather, they are treated by their GP (often the same GP who prescribed their opioids in the first place). GPs do not always know how to help patients manage their pain. Despite the widespread nature of this problem, most university medical programs in Australia still don’t have a pain curriculum. Even when GPs do have a good understanding of pain management, they are not able to formulate individualised plans for patients in 10 to 15 minute appointments. Medicare does not compensate GPs for the additional time required to manage such a complex health condition, so GPs are not rewarded for investing time and effort in these cases.
The risk of failing to address this issue is that we will see escalating anxiety and depression in a population that already experiences these issues at a rate higher than the general population, putting more burden on an already overwhelmed mental health system. There is also a fear that if patients are told they have to reduce their pain medication without being given an alternative, some will turn to illicit drugs to cope, as we have seen in the US.
This is a real dilemma and the problem is not going away. In fact, with an ageing population it is getting worse. Chronic pain affects one-third of adults over the age of 65 and already costs the economy billions of dollars each year, primarily as a result of health care costs and productivity losses. This issue needs to be a national health priority, with more attention and funding from policymakers. We need to raise community awareness of chronic pain, increase pain education across the healthcare system and provide better access to non-pharmacological approaches to pain management.
Dr Claire Ashton-James is a social psychologist and senior lecturer at the University of Sydney’s Pain Management Research Institute. Professor Paul Glare is a pain and palliative care specialist and is director of the Pain Management Research Institute.
They will be speaking at a symposium on opioid deprescribing for chronic pain at Taronga Zoo on November 29.