The National Pain Strategy has been a catalyst for major change in the way pain—especially chronic pain—is understood and managed in Australia. It has also been an inspiration for other countries.
Unlike many other worthy strategies, it was not left to languish in a bottom drawer. Rather it has been brought to life by the efforts of many organisations and individuals.
All Australian states have now adopted recommendations of the strategy, boosting the capacity of pain clinics to reduce wait times and enabling many to deliver telehealth services into regional areas.
At the same time, Australia has become a world-leading provider of best-practice pain management education and training programs to improve knowledge and clinical practice in pain management for all health professionals.
Statewide pain plans are now in place in Queensland, New South Wales, Western Australia and South Australia while Tasmania and the Australian Capital Territory are well advanced in their planning with a focus on developing community-based services.
Five new regional pain clinics have been established in Victoria making a total of 14 new regional pain clinics established across the eastern states—from La Trobe in Victoria to Townsville in Queensland.
A recent evaluation of the NSW Pain Plan shows waiting times are now down to 63 days (from 12 months or more two years ago) and patients attending a pain clinic report a reduction in pain severity, improved function and mood, and a positive impact on their capacity to work and their employment status.
A key outcome was a very significant reduction in the use of opioids by patients attending pain clinics, contrasting with an increase across the State in the total supply of opioids as reported in PBS data.
Big improvements have been made in access to specialist pain services for children and adolescents with the establishment of dedicated paediatric pain clinics at Lady Cilento Children’s Hospital in Brisbane and Princess Margaret Hospital in Perth—making a total of six specialist clinics in four states. Westmead Children’s Hospital and John Hunter Children’s Hospital are now providing specialist telehealth services for patients in regional and remote NSW.
Around half of the Primary Health Networks have identified a need for community-based pain services and NSW North Coast PHN has invested significant funding to trial and evaluate the effectiveness of a brief multidisciplinary pain management program in primary care.
The program will teach self-management strategies as an alternative to reliance on pain medication (especially opioids), preventing the potential for dependence and addiction. If self-management strategies can be taught effectively in the community it will mean that GPs could have local access to an alternative to prescribing opioids. Ideally, pharmacists will also be able to make referrals to these programs.
It is envisaged similar programs could be implemented by other PHNs, in particular those where pain—including musculoskeletal conditions like arthritis—has been identified as an area of need and those in regional areas where there is a high level of opioid prescribing as reported in the 2015 Australian Atlas of Healthcare Variation.
Painaustralia’s website (http://www.painaustralia.org.au/) is a gateway to a wide range of pain management resources for consumers, as well as to high quality education programs for health professionals developed by the Faculty of Pain Medicine and the Pain Management Research Institute. The website also has links to tools to help GPs assess and manage complex chronic pain and de-prescribe opioids developed by the NSW Agency for Clinical Innovation Pain Network.
Current health reforms offer scope to further improve management of pain. Painaustralia is contributing to the Medicare Benefits Schedule Review, which will consider new items for multidisciplinary pain management. Painaustralia is also is advocating for people with complex pain problems to have access to the trial of Health Care Homes, which offer an ideal model for team-based care for such patients.
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