Driven to specialists with pain
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.