Otago Daily Times

Chronic pain ser­vices un­der­funded: spe­cial­ists

- KAROLINE TUCKEY Health · Pharmaceutical Industry · Chiropractic · Mental Health · Medicine · Society · Industries · Alternative Medicine · Health Conditions · Wellington, New Zealand · Otago · New Zealand · Palmerston North · Arbeidersparty · Ministry of Health · University of Otago · Palmerston North · New Zealand Ministry of Health

WELLING­TON: Top clin­i­cians say chronic pain ser­vices serv­ing one of the coun­try’s largest pa­tient groups are be­ing starved of fund­ing, which is crip­pling lives and un­nec­es­sar­ily bur­den­ing fam­i­lies and so­ci­ety.

Dr Bron­wyn Len­nox Thomp­son teaches Otago Univer­sity med­i­cal school’s mas­ter’s in pain man­age­ment. She said one in five peo­ple suf­fered chronic pain, but not ev­ery DHB had a chronic pain ser­vice.

Dr Tipu Aamir, chair­man of the New Zealand com­mit­tee for the Fac­ulty of Pain Medicine, said chronic pain was the lead­ing cause of dis­abil­ity in New Zealand, and early in­ter­ven­tion and spe­cial­ist treat­ment could help many who were suf­fer­ing to live bet­ter lives, and keep their jobs.

Both have called for pain spe­cial­ists to be pro­vided in all ar­eas of the coun­try, and the fund­ing to be ring­fenced.

Tar­ryn At­twell has Down’s syn­drome, teaches sign lan­guage classes, has a busi­ness sell­ing her own sign lan­guage mer­chan­dise and goes to cheer­lead­ing classes.

The 20­year­old is known for be­ing bub­bly, ac­tive and out­go­ing, but for the past few months has been dou­bled up on the couch in level 10 pain.

Her mother, Ally At­twell, said that was not nor­mal for her daugh­ter, who had a high pain thresh­old and had barely even com­plained about bro­ken bones be­fore.

After sev­eral vis­its to Palmer­ston North Hospi­tal’s emer­gency depart­ment, she in­sisted Tar­ryn’s pain be in­ves­ti­gated.

Tar­ryn was ad­mit­ted, but told lit­tle could be done to di­ag­nose the prob­lem or pro­vide long­term treat­ment.

They were told her pain had gone so long it was now clas­si­fied as chronic pain, the chronic pain unit had just lost its sole re­main­ing staff mem­ber and other spe­cialty ar­eas were not able to take on chronic pain pa­tients.

‘‘The doc­tors and nurses at the hospi­tal have been amaz­ing, and they’ve been try­ing to look at how they can do it. It’s the sys­tem . . . The sys­tem had no way of sup­port­ing them,’’ Mrs At­twell said.

‘‘So they had the acute pain team com­ing around to see us and and check­ing in on us, but they’re acute pain not chronic pain, so there was noth­ing they could re­ally do.’’

After be­ing ap­proached by

RNZ and the lo­cal Labour Party of­fice, MidCen­tral DHB — which runs Palmer­ston North Hospi­tal — as­signed a med­i­cal team to in­ves­ti­gate care for Tar­ryn past the short­term im­me­di­ate treat­ment.

But her mother said there was no di­ag­no­sis or long­term an­swers yet, other than mor­phine and tra­madol she had to ad­min­is­ter at home.

The DHB con­firmed to RNZ there would be no staff in its chronic pain unit un­til next year due to a res­ig­na­tion. It said while there were no chronic pain ser­vices for out­pa­tients, acute pain and anaes­the­sia team mem­bers were as­sist­ing with in­pa­tients and out­pa­tients were be­ing man­aged by GPs.

Len­nox Thomp­son said the root of the prob­lem was na­tion­wide, and it was de­stroy­ing lives.

Un­like other health prob­lems, DHBs were not be­ing held ac­count­able for pro­vid­ing spe­cific chronic pain ser­vices, Dr Thomp­son said.

‘‘There’s no obli­ga­tion from the

Min­istry of Health for chronic pain ser­vices to be pro­vided. There’s no of­fi­cial level of care.

‘‘That means that in many parts of the coun­try there is no­body that can help man­age this group of peo­ple. A lot of ser­vices, a lot of parts of the coun­try, just don’t have any­body that they can call on, which is dev­as­tat­ing for ev­ery­body,’’ Dr Thomp­son said.

Pa­tients who qual­i­fied for ACC were of­ten re­ferred on to pri­vate ser­vices, but those who did not were left re­ly­ing on their DHBs.

A Min­istry of Health spokesman said DHBs were not re­quired to of­fer chronic pain ser­vices in their own area, but there were spec­i­fi­ca­tions for them to fund them some­where. This meant pa­tients should be able to ac­cess care through an­other DHB if their own did not of­fer it.

‘‘As fund­ing for pain man­age­ment ser­vices is de­volved to DHBs, they are re­spon­si­ble for de­ter­min­ing the ser­vice mix that best meet the needs of their pop­u­la­tions within the fund­ing avail­able.

‘‘In par­tic­u­lar, con­sid­er­a­tion is given to the likely ben­e­fits of the ser­vice for the in­di­vid­ual, rel­a­tive to the costs of that ser­vice and con­sid­er­a­tion of the ben­e­fits if those re­sources were di­rected to a dif­fer­ent ser­vice or an­other in­di­vid­ual’s treat­ment.’’

But Dr Thomp­son said the ser­vice was so es­sen­tial and de­mand so wide, pa­tients should not have to travel out­side their DHBs area, which in some cases was a very long dis­tance.

Star­ship Hospi­tal had an ex­cel­lent chronic pain unit, and was a good ex­am­ple of what could be done, and the ben­e­fits to peo­ple’s lives, she said.

Dr Aamir, a pain medicine spe­cial­ist, said chronic pain con­di­tions were the lead­ing cause of dis­abil­ity in New Zealand.

‘‘In New Zealand there is cur­rently 14 to 15 full­timee­quiv­a­lent po­si­tions for pain spe­cial­ists in the whole coun­try — the rec­om­mended spec­i­fi­ca­tion is one pain spe­cial­ist per 100,000 of pop­u­la­tion.

‘‘We should have ide­ally 50; we have only 15 po­si­tions. So that gives you an idea of how far back we are.

‘‘We need to do a lot of work. All lo­cal DHBs should have an in­ter­dis­ci­pli­nary pain ser­vice where peo­ple with chronic non­cancer pain are seen.’’

Both Dr Aamir and the Min­istry of Health spokesman said the min­istry’s own ad­vice rec­om­mended mul­tidis­ci­plinary teams be avail­able, which should in­clude pain spe­cial­ists, as well as ca­pac­ity to pro­vide ap­point­ments with ‘‘al­lied ser­vices’’ — phys­io­ther­a­pists, psy­chol­o­gists and oc­cu­pa­tional ther­a­pists.

How­ever, Dr Aamir said at present the bur­den of care for th­ese pa­tients of­ten fell on GPs, who were left do­ing what they could with­out spe­cial­ist skills or the re­sources to sup­port this group well.

‘‘The re­al­ity is that in a 15 to 20­minute GP as­sess­ment, GPs don’t have enough time to re­ally deal with the com­plex­ity of the pa­tients.

‘‘Once they’ve iden­ti­fied that this per­son has chronic pain, the next step is to re­fer them to a team who knows how to deal with is­sues . . . but they don’t have [spe­cialty] ser­vices to re­fer them on to, and if they don’t have a path­way then that per­son re­mains stuck.’’

He called for more ser­vices to be pro­vided within DHBs at the com­mu­nity level, and for fund­ing for spe­cial­ists to be ‘‘ringfenced’’.

‘‘Pain con­di­tions are caus­ing the max­i­mum amount of dis­abil­ity. If we can pre­vent dis­abil­ity in a pa­tient — we might not be able to com­pletely erad­i­cate it — but if we can pre­vent dis­abil­ity, and we can help peo­ple to re­turn to work or to some­thing else . . . ob­vi­ously in­di­vid­u­als and so­ci­ety are go­ing to be far bet­ter off.’’

Mrs At­twell said that since she had been in­ves­ti­gat­ing help for Tar­ryn she had heard from many chronic pain suf­fer­ers who said they had had lit­tle med­i­cal sup­port, and she was shocked by the ex­tent of the prob­lem

A GP had re­ferred them to a chronic pain ser­vice at a neigh­bour­ing DHB, and they were ini­tially told by the ser­vice most peo­ple waited months to be seen, and some would not even get an ap­point­ment de­spite a re­fer­ral, she said.

‘‘They told me it was go­ing to take months. That just was too long for me watch­ing my daugh­ter ly­ing on a couch not mov­ing and not want­ing to eat, and me hav­ing to pump her with all th­ese opi­oid drugs to keep her semi­func­tional.’’

Tar­ryn had now been ac­cepted to be seen by the neigh­bour­ing DHB’s ser­vice, but it had been a roller­coaster, Mrs At­twell said.

‘‘I think it’s not OK. I think we need some­one here.’’

The rig­ma­role in­volved in get­ting help had been es­pe­cially frus­trat­ing be­cause two years ago Tar­ryn had a sim­i­lar pain but fell un­der Star­ship Hospi­tal’s care. It was able to of­fer a one­off treat­ment that took the pain away long term.

She wanted this tried again, but de­spite agree­ment from in­di­vid­ual doc­tors, had been told by both DHBs it was un­likely to be made avail­able to her through the pub­lic health­care sys­tem.

It was heart­break­ing a group of peo­ple al­ready suf­fer­ing over­whelm­ing and de­bil­i­tat­ing med­i­cal con­di­tions were left to fight for the level of help most New Zealan­ders would as­sume they were en­ti­tled to, and she be­lieved chronic pain suf­fer­ers had be­come marginalis­ed and for­got­ten, she said. — RNZ

 ?? PHOTO: GETTY IM­AGES ?? Com­mon curse . . . Chronic back pain is a com­mon curse.
PHOTO: GETTY IM­AGES Com­mon curse . . . Chronic back pain is a com­mon curse.
 ?? PHOTO: SUP­PLIED ?? Strug­gling . . . Tar­ryn At­twell (cen­tre) suf­fers from chronic pain and her fam­ily is strug­gling to find help.
PHOTO: SUP­PLIED Strug­gling . . . Tar­ryn At­twell (cen­tre) suf­fers from chronic pain and her fam­ily is strug­gling to find help.

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