As we deal with the impacts of the COVID-19 pandemic on the health and wellbeing of our population, the challenges are greater for the thousands of Australians in rural, regional and remote parts of our country who live with chronic pain.
For many people living with chronic pain in these areas, their starting point before the pandemic was already compromised by extreme isolation, higher rates of medication prescription and a lack of pain management services, including access to much-needed allied health professionals.
We know that people who live in rural, regional and remote Australia are more likely to have chronic pain than those who live in major cities. Some pain conditions are even more prevalent in rural communities. For back pain, the most common form of pain, people who live outside major cities are 23 per cent more likely – and those aged 55 to 64 are 30 per cent more likely – to live with it compared with urban areas.
Higher rates of pain may be associated with rural industries such as agriculture, mining, forestry and fishing which have higher rates of injury. Excess body weight is implicated in painful conditions such as osteoarthritis and represents another contributing factor.
Yet there are very few pain specialists and pain clinics in rural and regional areas, with the overwhelming majority of services (89 per cent) located in a major city. Many of the health professional disciplines that are integral to pain management, such as occupational therapists, physiotherapists and psychologists, are rare in rural and remote communities.
It is highly likely that higher rates of medication prescription in rural and regional Australia reflect higher prevalence rates of chronic pain and decreased access to appropriate treatments. GPs in more remote Medicare locations are less likely to refer patients living with chronic pain to another health professional (largely because they are not available).
However, access to pain management services and allied health professionals is essential if we are to stop the rising prevalence of chronic pain across Australia. There are currently 3.4 million Australians living with chronic pain and this is expected to increase to 5.2 million by 2050 if we do nothing.
The increase in telehealth for medical services during the pandemic has definitely provided better access to some services for people with chronic pain across all geographical areas. However, going forward, it must be seen as complementary to, rather than a substitute for, face-to-face consultations.
It is also critical to consider the needs of Aboriginal and Torres Strait Islander peoples, with pain management in this area severely lacking.
Painaustralia supports the National Rural Health Alliance’s proposed trial of rural area community-controlled health organisations (RACCHOs), with health professionals employed as part of multidisciplinary teams in community-based health organisations that are, importantly, affordable and accessible.
We believe such trials would attract the necessary workforce and allied health professionals to offer multidisciplinary care that is paramount to chronic pain management in these communities.
There are other models of care, such as the ECCHO program and pain revolution, that optimise the delivery of quality pain management in rural and remote communities of Australia. These models are worthy of further support and expansion.
While there is no doubt that people in rural and remote parts of Australia experience increased prevalence of chronic conditions (including chronic pain) and find it difficult to access quality care, there are models that are showing good promise. We need a concerted effort to highlight these disparities and engage funding and support in communities to address the growing demand for chronic pain management.