Revolutionising chronic pain across rural Australia

Australians living in rural, regional and remote settings are 25% more likely to experience a chronic pain problem. It can be difficult for health professionals in any setting to provide evidence-based care for chronic pain when this requires advanced skills that are not always taught in university training. Professional development opportunities, clinical guidelines and resources are often ‘metro-centric’, lacking relevance to non-metro settings.  

These challenges triggered the establishment of Pain Revolution – a non-for-profit initiative of the University of South Australia that is working to build local capacity.

Their annual Rural Outreach Tour involves a group of cyclists and an education team riding town-to-town delivering professional development and free community education events. These events raise awareness, spark curiosity and foster understanding about modern pain care. To date, over 10,000 people have attended these events across 47 towns in five Australian states.

“It’s not ‘just' a charity ride” says Dr Dianne Wilson, the Tour’s Education Manager. “Everyone on tour wants to improve outcomes and support rural communities. They have to apply to ride and they contribute en route.”  It’s a novel model seeking to serve communities first and raising funds to support Pain Revolution scholarships along the way. The approach has caught the attention of international decision makers, with replications underway in the UK, Europe and North America.

Pain Revolution’s scholarship program, also supported by Primary Health Networks and other local interest holders, funds Pain Revolution’s Local Pain Educator (LPE) program. Rural health professionals apply for scholarships to partake in the LPE program’s two-year intensive upskilling. LPE’s form interdisciplinary learning circles in their communities that facilitate knowledge exchange, problem solving, and collaborative case management. So far, Pain Revolution has trained 93 LPEs.

Tanushka Alva, the LPE Program Manager, described it as “an innovative capacity building program where Pain Revolution becomes a part of the fabric of rural and regional communities.”

Professor Lorimer Moseley, AO, founder and leader of Pain Revolution, emphasised the unique advantages of rural settings to build these collaborative learning circles, “We see great value in working alongside rural communities, tapping into the beautiful networks that are already in place and collaborating in a way that empowers rural health professionals to be leaders in their community around chronic pain. To truly transform pain-related outcomes in a sustainable way.”

Pain Revolution’s bold ambition comes with challenges. Providing evidence-based pain care can be difficult when structural constraints do not promote it, and peers may not support it. To help scholarship holders negotiate these challenges, the LPE program offers one-on-one mentoring support and a community of other LPEs working towards better outcomes.

The LPE program has helped improve pain care quality, decreased the prescribing of risky medications, as well as improving clinical outcomes and improving retention of health professionals on country. LPEs complete the program feeling energised, having gained a sense of connection to other like-minded health professionals and to their community.

Sunshine Coast physiotherapist Tim Bagshaw completed the LPE program in 2022 and, like many LPEs, has transformed his work because of the program. “This stuff really makes a difference in the real world – not just in research papers. I now work in a persistent pain team and am seeing firsthand how beneficial pain education can be.”

LPEs have also established new interdisciplinary and cross-system communication and referral pathways. Many drive innovation in their communities by generating pain education interventions and pushing for state-wide change.

The biggest challenge, says Tanushka, is meeting scholarship needs – “last LPE round, we had 90 applications for just 15 scholarships.” Pain Revolution is looking for collaborators who want to support sustainable capacity building in pain care.