Rising dependence, accidental overdose, hospitalisations and death among opiod users is presenting Australia with a very serious situation. The AIHW report, ‘Opioid harm in Australia: and comparisons between Australia and Canada’ paints a bleak picture of the harms to those using opioids like oxycodone, codeine and morphine. Over three million people were prescribed 15.4 million opioid scripts in 2016, and with an average of 3 deaths per day. We are facing a very serious situation in Australia.
It is vital we find more effective pathways for the self-management of chronic pain. The most effective approach to reducing pain-related disability, improving function and quality of life, and increasing the chances of returning to work for people with chronic pain is to recognise that chronic pain is not just a physical condition but an experience that affects people psychologically, emotionally and socially.
In recent years there has been a shift in health policy discussions. Phrases like ‘consumer-centred care’ and ‘patient-centred care’ have become commonplace. With the focus on Partnering with Consumers enshrined as Standard 2 under the National Safety and Quality Healthcare Standards (NSQHS), we are beginning to make progress in developing more respectful partnerships between health service organisations, health professionals, patients, families, carers and consumers.
The most effective approach to reducing pain-related disability, improving function and quality of life, and increasing the chances of returning to work for people with chronic pain is to recognise that chronic pain is not just a physical condition but an experience that affects people psychologically, emotionally and socially.
We still have a long road ahead of us, especially when it comes to ensuring that consumers are empowered to participate as partners in their health journey. We have seen numerous examples where, despite best intentions, health policy has failed the very people it aims to serve. The recent roll out of Consumer Directed Care across Home Care Packages in aged care has resulted in a steep increase in administration fees, with consumers losing funding rather than gaining control.
A huge part of the dilemma here is that often our objective of consumer education is limited to raising awareness. Far more needs to be done to provide consumers with the tools they need to be able to not only understand their health issues, but to also self-manage and steer the direction of their health care. This is particularly relevant for the management of chronic conditions, where people need to develop the skills to manage their risk factors, monitor their conditions, make effective use of services and medications, and cope with the impact of ill-health on their lives.[i]
This is the direction that both the National Pain Strategy and the National Strategic Action Plan for Pain Management have taken. Like many other developed countries, Australia is facing a pain epidemic. It is one of the leading causes of disability, absenteeism and forced early retirement in Australia. New research by Deloitte Access Economics on the cost of pain in Australia in 2018 indicates that 3.24 million Australians live with chronic pain today. This figure is projected to increase to 5.23 million by 2050, as Australia’s population ages and the prevalence of chronic conditions – many of which are significantly associated with chronic pain – continues to increase, costing Australia over $73 billion annually ($139.3 billion if quality of life impacts are included). These staggering numbers represent an immense toll on our communities.
It will be impossible to manage the growing prevalence and impact of chronic pain without providing consumers with the skills they need to self-manage their care. We have seen the devastating results of a relying on purely a biomedical model to deal with this complex condition. While the ‘opioid crisis’ here in Australia is not comparable in magnitude to the issues faced in countries like the Untied States, opioids and related harms continue to represent an increasing risk to Australian communities.
Management of pain must be holistic in order to be effective. This requires coordinated interdisciplinary assessment and management involving, at a minimum, physical, psychological, and social/environmental risk factors in each patient. This is known as the biopsychosocial (or more recently sociopsychobiomedical) prism from which to view a complex health issue like pain from different angles. Treatment is not ‘one-size-fits-all’ but needs to be person-specific. Pivotal to this approach is the consumers understanding, and participation in the management of their own care.
Above all, changing common beliefs about pain and its treatment is critical to achieving better outcomes from pain management. Consumers need greater confidence to seek out best practice treatment and be active participants in their remedial journey as well as building resilience in their self-management of chronic pain.
[i] Dean K, Kickbusch I. Health related behaviour in health promotion: utilizing the concept of self care. Health Promot Int 1995; 10: 35-40.