Chronic pain services underfunded: specialists
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