Uncategorized — 30 October 2012

The recent National Drug and Alcohol Research Centre report raising alarm about increasing numbers of deaths from prescription opioids, reflects a much bigger issue: the millions of Australians whose lives are severely affected by chronic pain.

At least one in five Australians, including children, lives with chronic pain; among people aged over 65, it’s one in three. The report’s revelation there were more than 500 opioid-related deaths in a year – the majority from prescription drugs such as oxycodone – is indeed tragic. In 2008 deaths from prescription drugs were more than double the number of accidental overdose deaths from heroin. But the number of young people whose lives are ruined because of chronic pain is devastating on an even bigger scale.

Opioid drugs such as oxycodone play a valuable role in treating acute pain, especially after surgery or trauma. However, they may not be suitable for the treatment of long-term chronic pain from a disease or injury.

Among the vast majority of people with chronic pain, other measures such as cognitive behavioural therapy, exercise, physio or occupational therapy and meditation, can actually be more effective in managing, if not eliminating the pain.

However, such programs are not covered by Medicare or health insurance so are available to relatively few people who could benefit from them. Plus waiting times at pain clinics may range from six month to two years.

The Royal Australian College of General Practitioners and the federal government are pushing for a nationwide electronic system that would allow pharmacists, doctors and state health authorities to monitor the prescribing and dispensing of addictive drugs.

But it is not helpful to call for further restrictions on prescribing opioids. A more rational and strategic approach to managing pain in a holistic and enlightened manner, is by far the best way to tackle this problem.

We need to transform the way doctors, and their patients, think about pain. The experience of pain is subjective, and is influenced by physical, psychological and environmental factors. I have lived with chronic pain from osteoarthritis since my 30s, which forced me to retire from my work and sports I loved, such as tennis, golf and sailing. I have had two hip replacements and a shoulder replacement, but continue to live with pain from arthritis in my spine and other joints. I manage it with non-opioid medication, hydro and physiotherapy but now have difficulty walking and even swimming. I have used opioids including oxycodone for post-surgical pain but as a pharmacist I knew I could not continue this long term.

Pain is the most common symptom reported by people visiting a GP. Pain-relieving medications are the most frequently requested over-the-counter medication in pharmacies.

About 20 per cent of suicides are linked to physical problems, often associated with chronic pain. The most common reasons for people of working age to drop out of the workforce are back problems and arthritis – both associated with severe, debilitating chronic pain.

The National Pain Strategy, developed by more than 150 healthcare professionals and consumers at a 2010 national summit, recommended chronic pain be recognised as a priority health issue and constitute a disease in its own right. Yet it remains one of the most neglected areas of healthcare.

While committing the resources needed for a strategic national campaign, similar to those for chronic heart disease and cancer, may be a bridge too far for government in the fiscal climate, one option could be a “Better Outcomes in Pain Management” program. It could be treated nationally through Medicare as we do for mental health.

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We would need to provide education and training for health professionals in multi-disciplinary pain management, and introduce strict guidelines on prescribing and managing opioids, including a timeframe for ceasing the drugs.

We should provide better access to integrated approaches to pain management including medical, psychological and physical therapies such as massage and acupuncture appropriately, paid for by Medicare (again, as we do for mental health.)

We need to develop community education and support networks for people living with pain, such as those run by not-for-profit bodies such as the Australian Pain Management Association, with its Pain Link helpline, and Chronic Pain Australia.

The Mackay Pain Support Group in north Queensland is an example where this community approach is working well.

Patients need to be referred seamlessly from primary care through to a specialist pain clinic followed up by ongoing support in the community. Telehealth could help ensure better access to pain management services in regional areas and indigenous communities, which are among the most vulnerable.

The alarm over opioid deaths needs to be considered as part of a much bigger problem requiring a strategic, humane approach to addressing chronic pain in our community.

Lesley Brydon is CEO of the non-profit Painaustralia.


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