Driven to spe­cial­ists with pain

The Weekend Australian - Travel - - Health -

From Health cover peo­ple from ex­er­cis­ing, in­creas­ing their risk of de­vel­op­ing other ill­nesses such as di­a­betes or car­dio­vas­cu­lar dis­ease. That sort of com­plex­ity means pa­tients do best when they have ac­cess to a multi-dis­ci­plinary team that can ad­dress the mul­ti­ple needs they have, says Amal Helou, pres­i­dent of the Aus­tralian Pain So­ci­ety and a nurse prac­ti­tioner spe­cial­is­ing in pain man­age­ment. Ideally that oc­curs in spe­cial­ist pain man­age­ment cen­tres.

But out­side cap­i­tal cities such clin­ics are rare, and even at the ex­ist­ing clin­ics in ma­jor cities, wait­ing lists are longs and pa­tients wait six to 12 months for treat­ment, Helou says.

Those in rural and re­gional ar­eas of­ten get no ac­cess at all.

‘‘ Of­ten pa­tients end up get­ting one on one treat­ment from their GP, rather than a co­or­di­nated team approach, but if you treat only one com­po­nent of the pain you risk ig­nor­ing other as­pects. For ex­am­ple, if you sim­ply med­i­cate to treat pain, you fail to deal with is­sues such as the pa­tient’s mo­bil­ity.

‘‘ If the pa­tient is not mov­ing around or ex­er­cis­ing be­cause of the pain, their mus­cles could waste away.’’

By con­trast, a pa­tient at Royal Prince Al­fred Hospi­tal Pain Man­age­ment Cen­tre where Helou works would have ac­cess to oc­cu­pa­tional ther­a­pists, phys­io­ther­a­pists, clin­i­cal psy­chol­o­gists and psy­chi­a­trists, neu­rol­o­gists, pain medicine ex­perts, re­ha­bil­i­ta­tion spe­cial­ists and drug and al­co­hol coun­sel­lors. They may also be able to ac­cess spe­cial­ist tech­niques they can’t get else­where. Pa­tients are taught self man­age­ment tech­niques to ac­tively man­age their pain. This could be any­thing from cog­ni­tive be­hav­iour ther­apy to ‘‘ mind­ful­ness’’ med­i­ta­tion to stretch­ing ex­er­cises and more. ‘‘ They look at the whole per­son,’’ she says.

On the other hand, many pa­tients con­tinue to be pre­scribed painkillers such as mor­phine and sent on their merry way, says Dr Roger Goucke, dean of the Fac­ulty of Pain Medicine, and head of the de­part­ment of pain man­age­ment at Sir Charles Gaird­ner Hospi­tal in WA. ‘‘ But if you give a pa­tient a high dose of mor­phine over a long pe­riod of time, it tends to make things worse. It might help a lit­tle un­til the pa­tient gets used to it, but there are loads of side ef­fects, and when a pa­tient gets de­pen­dent on mor­phine it can make things worse,’’ Goucke says.

He and Cousins say that while great strides have been made in some ar­eas, such as hav­ing pain medicine recog­nised as a spe­cialty in its own right in 2005, un­der­grad­u­ate cov­er­age of pain medicine is still min­i­mal and more train­ing po­si­tions are needed.

‘‘ Doc­tors and al­lied health pro­fes­sion­als’ knowl­edge re­gard­ing pain man­age­ment is not suf­fi­cient,’’ Goucke says. ‘‘ There are psy­cho­log­i­cal tech­niques and ex­er­cise pro­grams that can be tar­geted for peo­ple with pain, that can greatly im­prove qual­ity of life — but health pro­fes­sion­als don’t know about them.’’

The re­sult, he, Cousins and Helou say, is that pa­tients of­ten find them­selves not get­ting ad­e­quate re­sults.

‘‘ Pa­tients be­come like a bil­liard ball bounc­ing around a bil­liard ta­ble,’’ Cousins says. ‘‘ They’re passed from spe­cial­ist to spe­cial­ist in a se­rial at­tempt to make things bet­ter.’’

Ac­cord­ing to Goucke and Cousins, out­comes could be much bet­ter if pa­tients had ac­cess to best prac­tice treat­ment im­me­di­ately af­ter surgery, in­jury or short-term painful ill­nesses like shin­gles, be­cause when acute pain is ag­gres­sively man­aged it’s sig­nif­i­cantly less likely to progress into per­sis­tent pain.

The more se­vere the pain, the more likely the pa­tient is to ex­pe­ri­ence chronic pain.

To com­bat that, ex­perts say sev­eral treat­ments aimed at dif­fer­ent tar­gets can be com­bined. For ex­am­ple, if some­one is ex­pe­ri­enc­ing sig­nif­i­cant pain be­fore an am­pu­ta­tion, they might be given four dif­fer­ent drugs that work to­gether to min­imise pain. Some might be in­jected di­rectly into the spine, oth­ers given in­tra­venously, each with a slightly dif­fer­ent func­tion.

‘‘ There’s an op­por­tu­nity for pre­ven­ta­tive treat­ments — we can ef­fec­tively re­lieve 90 per cent of acute pain, but cur­rently less than 50 per cent of pa­tients get ac­cess to that,’’ Cousins says.

‘‘ It’s rel­e­gated to an unim­por­tant role and some­times handed down to the most ju­nior staff. Most peo­ple with per­sis­tent pain are seek­ing help and try­ing to do some­thing about it, but they aren’t get­ting any­where.

‘‘ There are fairly mea­gre re­sources in Aus­tralia,’’ he says.

Re­sults of the Pain Man­age­ment Re­search In­sti­tute and MBF Foun­da­tion study are ex­pected by the end of the year.

‘‘ Fed­eral and state gov­ern­ments could save enor­mous amounts of tax­pay­ers’ money by pro­vid­ing the re­sources to de­liver proper treat­ment,’’ Cousins says.

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