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Pain, a Chronic Issue

Painaustralia CEO Carol Bennett addresses a fundamental health issue impacting the quality of life for millions of Australians, and implores GPs and allied health professionals to better equip themselves to manage chronic pain in an aged care setting in particular.

  Chronic pain – constant daily or recurrent pain – is a common condition in Australia. With one in five GP consultations involving a patient with chronic pain, GPs already know how important diagnosis and treatment of chronic pain is for many patients.

  It is well known that the prevalence of chronic pain increases with age. As many as one in three older people are living with pain in the community, as are the majority of aged care residents. , However, many older Australians experience unrecognised or undiagnosed pain and are being under-treated, often due to cognitive and communicative impairments. In fact, evidence shows people with dementia in particular are being under-treated for their pain.

  There are also challenges with reporting pain in cognitively intact people. Many older people believe pain is a normal part of ageing and that there is little potential for improvement. They fear addiction to pain medications or other side effects; they’re concerned that pain may suggest worsening of disease; they’re worried they will be seen as people who complain too much; and are also reluctant to seek help for fear of further functional dependence due to disease progression.

  Poorly managed pain can severely reduce function and quality of life for patients, increase distress to families and create a greater burden of care for carers and staff. In people who are non-verbal, untreated chronic pain can result in Behavioural and Psychological Disturbances (BPSD) and lead to inappropriate use of chemical and physical restraints. It is estimated that about half the people in aged care and about three quarters of those with dementia are receiving psychotropic medications, which in some cases have been prescribed inappropriately.

  While access to pain management is acknowledged globally as a fundamental human right, the sad reality is that most of Australia’s aged care facilities are falling well short of providing effective pain care, and there is a lot more we could be doing in primary care as well.

 A recent survey found 41% of care professionals have had no training on assessment of pain in people with dementia, while 90% believe additional training would be beneficial. Recognition of BPSD as signs of pain in people with cognitive impairment is critical to accurate assessment of pain. The Australian Pain Society guidelines Pain in Residential Aged Care Facilities – Management Strategies (the new guidelines are currently in second draft edition) provide some excellent ways to identify pain in non-verbal patients. The training however, must be broader than that.

As the health professional coordinating multidisciplinary care plans and the primary point of contact with the patient, a supportive and understanding GP well-versed in best-practice pain management is critical...

 Chronic pain is far more complex than acute pain. Although it is often associated with surgery, trauma or other conditions, it can exist without a clear reason at all, and mounting evidence suggests it can be a disease in its own right. More than a physical sensation, it is an individual human experience influenced by physical, psychological and environmental factors, and shaped by attitudes, beliefs and personality.

 Patients often see multiple doctors and undergo many investigations and interventions before arriving at a meaningful diagnosis. This process can take several years. Meanwhile, the patient pain condition and quality of life worsens, often impacting employment and relationships.

 Those with difficult to diagnose pain, or conditions that cannot be detected with a scan or test, are at risk of not being believed, and this can exacerbate to feelings of isolation and depression.

 There is still limited understanding of multidisciplinary pain management, now considered the most effective way to reduce disability, and improve patient function and quality of life. Also known as a bio-psycho-social approach, it aims to address all the factors in the pain experience. However, multidisciplinary pain management programs designed for older people, such as the Seniors ADAPT program delivered by the Pain Management Research Institute in Sydney, are few and far between, and there is insufficient provision of allied health support through the Aged Care Funding Instrument to allow for best-practice care.

 The role of the GP in supporting patients with chronic pain cannot be underestimated. As the health professional coordinating multidisciplinary care plans and the primary point of contact with the patient, a supportive and understanding GP well-versed in best-practice pain management is critical in helping patients feel validated and steering them towards better quality of life. Allied health professionals also play a key role.

 Appropriate and ongoing education and training of clinicians, allied health professionals and staff who care for our older Australians is vital for the provision of high quality residential aged care and care in the community. There must be a greater understanding of pain assessment, particularly in non-verbal patients, as well as best-practice pain management.

 If the Australian Government is going to focus more attention on addressing quality health care in our aged care facilities, it may provide a generational opportunity to recognise and adequately address the need for better pain management in all our aged care settings.

 As GPs and allied health professionals become better equipped with increased knowledge about pain assessment and management, positive change will happen.

 With an ageing population, and more people becoming aware of the impact of pain in our communities, the issue of effective pain management in aged care, and in all our communities, is emerging as a fundamental health issue impacting quality of life for millions of Australians.

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 To learn more about chronic pain and pain management click here.

Painaustralia is a national advocacy body formed in 2011 to work with government, health professional and consumer stakeholders to facilitate implementation of the National Pain Strategy. To find out more please visit www.painaustralia.org.au

References

  • 1 Why is unmanaged pain still a problem? MJA 2012 196(6):371) https://www.mja.com.au/journal/2012/196/6/why-unmanaged-pain-still-problem
  • 2 Centre for Epidemiology and Research. 2008 Report on Adult Health from the New South Wales Population Health Survey. Sydney: NSW Department of Health, 2009
  • 3 AIHW Australian GP Statistics and Classification Centre, SAND abstract No. 150 from the BEACH program: Chronic pain in general practice patients, 2010
  • 4 Department of Health and Ageing 2012
  • 5 Gibson SJ, The IASP Global Year Against Pain in Older Persons: Highlighting the current status and future perspectives in geriatric pain Expert Reviews in Neurotherapeutics, 2007:7(6), 627-635
  • 6 Gibson S, Pain management in residential aged care facilities, AFP 2015 44(4)
  • 7 AIHW Australian GP Statistics and Classification Centre, SAND abstract No. 150 from the BEACH program: Chronic pain in general practice patients, 2010
  • 8 Alzheimer’s Australia, Consumer Engagement in the Aged Care Reform Processes, 2012
  • 9 Peisah C & Skladzien E, Alzheimer’s Australia Paper 38: The use of restraints and psychotropic medications in people with dementia, 2014
  • 10 Holmes A, Christelis N & Arnold C, Depression and chronic pain, MJA Open 2012; 1 Suppl 4:17-20
  • 11 Demyttenaere K et al., Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys. Pain 2007;129:332-342
  • 12 Fine PG (2011) Long-Term Consequences of Chronic Pain: Mounting Evidence for Pain as a Neurological Disease and Parallels with Other Chronic Disease States, Pain Medicine 12:996–1004
  • 13 Cousins MJ & Gallagher RM Fast Facts: Chronic and Cancer Pain, 2011


Breonny RobsonCarol Bennett, Painaustralia CEO
Passionate about improving the quality of health care in Australia, Carol has worked at senior executive levels in peak national and state health and aged care organisations including as Chief Executive Officer of Alzheimer’s Australia, Consumers Health Forum of Australia, Hunter Medicare Local, Rural Health Workforce Agency and the Victorian Alcohol and Drug Association. Carol has also managed her own consulting business working with national peak groups and has served on national and international boards and advisory groups.