Preventing the development of chronic pain


Findings Brief: Supporting PHNs to reduce the burden of chronic pain

This project developed a framework of options to address the management and secondary prevention of chronic pain for PHN decision-makers. It also played an important role in supporting collaboration and information sharing between PHNs to support implementation. Download a summary of the project's findings. 

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Project title: Preventing and better managing chronic pain in primary care

What is the issue?

Chronic pain is a considerable, and growing, public health issue. One in five Australians lives with chronic pain, including adolescents and children. This prevalence rises to one in three people over the age of 65. One in five GP consultations involves a patient with chronic pain and 10% report severe, disabling chronic pain. This prevalence is expected to increase as Australia’s population ages.

Early intervention and adoption of evidence-based treatment could halve the economic cost of chronic pain, estimated at $34 billion. However, the key issue in this area is access to effective pain assessment, prevention, self-management and non-pharmacological pain management services.

Pain particularly impacts vulnerable groups in the community, such as those with mental health issues, women and children, and is more prevalent in lower socio-economic communities. At the same time, lack of access to services is especially critical in rural, regional and remote areas and Aboriginal communities. The lack of access to pain management programs in these areas is one reason why the number of opioid prescriptions is 10 times higher in some areas of Australia.

How did the project address the issue?

The project focused on initiatives to improve the prevention and management of chronic pain in primary care. Its objectives were to prevent acute pain from becoming chronic pain (for example, post-surgery or post-trauma pain) and to better manage chronic pain to prevent the progression to disabling chronic pain. It also aimed to reduce the demand for opioid and interventional pain management services, especially where other approaches including self-management are more appropriate.

As the key to prevention is to identify people early in their pain journey, this project concentrated on primary care. Moreover, the size of the potential population is unlikely to ever be addressable through specialist pain services, although we recognise that adequate access to such services is a key component of the overall strategy to reduce the burden of chronic pain in Australia.

This project focused on Primary Health Networks (PHNs) as they serve as important levers as commissioning bodies and supporters of primary health care services.

What were the outcomes?

The project steering group consisted of 20 members including researchers, clinicians, PHN representatives and consumers who met twice per year via teleconference throughout the duration of the project. Overall, the project: 

  • Synthesised the evidence relating to initiatives (including models of care, programs and strategies) that have been implemented to improve the prevention and management of chronic pain in primary care in Australia
  • Improved understanding around the needs and priorities of PHNs in relation to the prevention and management of chronic pain in primary care
  • Improved understanding of the scope of work recently undertaken and commissioned by the PHNs in relation to the prevention and management of chronic pain in primary care and gaps
  • Improved understanding of the barriers and enablers PHNs encounter when implementing and sustaining initiatives to improve the prevention and management of chronic pain
  • Improved PHN knowledge around the evidence relating to the prevention and management of chronic pain initiatives in primary care (including initiatives undertaken by other PHNs and other initiatives reported in the literature)
  • Fostered collaboration and partnership between PHNs about initiatives related to chronic pain
  • Improved PHNs understanding of good implementation and evaluation and the keys aspects to consider when delivering and commissioning out initiatives.

Relevance for practice

The project developed communication tools and conducted workshops to inform PHNs about the opportunities to improve the prevention and management of chronic pain in primary care and to focus PHNs on good implementation and evaluation strategies.

Start date: January 2018

End date: December 2020

Project lead

Professor Fiona Blyth AM, University of Sydney

Project team

Professor Andrew Wilson, Director, The Australian Prevention Partnership Centre

Ms Pippy Walker, The Australian Prevention Partnership Centre

Dr Simone De Morgan, University of Sydney

Leah Marks, University of Sydney

A steering committee has been identified involving nominees of Pain Australia and relevant experts from Victoria, Queensland, Western Australia and South Australia.

Funding for this research has been provided from the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.

This project has now been completed. The final outcomes are listed below.

Phase 1 (January 2018 – June 2019) focused on reviewing the literature, PHN consultations

  • A comprehensive literature review to identify primary care initiatives focused on the secondary prevention and management of chronic pain
  • A review of PHN Needs Assessments to understand their health and service needs related to chronic pain
  • Consultation with PHNs to understand their needs and priorities related to chronic pain and currently implemented chronic pain initiatives
  • A workshop for PHN representatives to present our findings and increase awareness of opportunities for prevention and management of chronic pain. Read the PHN chronic pain workshop summary
  • Development of a resource on available online and accessible primary care chronic pain initiatives and resources.

Phase 2 (July 2019-December 2020) built on the findings from phase 1 to focus on the secondary prevention of chronic pain. This included:

  • Conducting a rapid review and mapping of options for Primary Health Networks
  • Hosting a deliberative dialogue to bring PHN representatives together to discuss options and considerations when implementing initiatives focused on the secondary prevention of chronic pain.

Phase 3 (January – December 2020) focused on the commissioning of community-based pain programs as a key initiative identified as being evidence-based and able to address both the secondary prevention and management of chronic pain in primary care by PHNs. This phase involved:

  • A webinar on how to adapt community-based pain programs during COVID-19
  • An eDelphi study to establish expert consensus on the key elements of community-based pain program design and implementation enablers.
  • A survey of PHNs to identify currently commissioned models of community-based pain programs
  • Producing a report and hosting a webinar to present the results from the eDelphi study and PHN survey and discuss how program models address our established key elements and implementation enablers.

Findings

Publication

Factsheet

Reports, resources, and event summaries

Prevention Works podcast

Conference posters and presentations

  • Pippy Walker, Simone De Morgan, Andrew Wilson, Fiona M Blyth. Community-based pain programs commissioned by Primary Health Networks and COVID-19 adaptations, Public Health Association of Australia Preventive Health Conference, May 2021, Virtual oral presentation.
  • Pippy Walker, Samuel Cornell, Simone De Morgan, Carissa Bonner, Fiona M Blyth. Are Primary Health Networks identifying opportunities for prevention? A needs assessment review, Public Health Association of Australia Preventive Health Conference, May 2021, Virtual oral presentation.
  • Pippy Walker, Simone De Morgan, Andrew Wilson, Fiona M Blyth. Establishing expert consensus on community-based pain program design and implementation: an eDelphi study, 2021 Australian Pain Society 41st Annual Scientific Meeting, April 2021, Virtual poster presentation (pre-recorded 3-minute presentation).
  • Pippy Walker, Simone De Morgan, Fiona Blyth. Commissioning community-based pain programs: supporting Primary Health Networks, Sydney Musculoskeletal, Bone & Joint Health Alliance,4th Annual Scientific Virtual Meeting, July 2020, Oral presentation.
  • Anne Daly, Matt Pearce, Justine McLean, Gabrielle Watt, Louise Brennan, Simone De Morgan. A telementoring partnership in Western Victoria using the Project ECHO model: development and implementation, Australian Pain Society 40th Annual Scientific Meeting, April 2020, Online poster presentation.
  • Simone De Morgan, Fiona Blyth, Pippy Walker, Andrew Wilson. Review of Primary Health Network Chronic Pain Initiatives: Summary of the findings from the consultation with Primary Health Networks, Australasian Association for Academic Primary Care (AAAPC) Conference, University of Adelaide, July 2019, Poster presentation.
  • Simone De Morgan, Pippy Walker, Andrew Wilson, Fiona M Blyth. The role of Primary Health Networks in improving the prevention and management of chronic pain in primary care,  Emerging Health Policy Research Conference, University of Sydney NSW, June 2019, Oral presentation.
  • Simone De Morgan, Fiona M Blyth, Pippy Walker, Andrew Wilson. The role of Primary Health Networks in improving the prevention and management of chronic pain in primary care, Australian Pain Society 39th Annual Scientific Meeting, Gold Coast QLD, April 2019, Poster presentation.
  • Pippy Walker, Samantha Rowbotham, Andrew Wilson, Fiona M Blyth. Preventing chronic disabling pain: assembling evidence to support system change, Menzies Centre Emerging Health Policy Research Conference, University of Sydney, July 2018, Oral presentation.
  • Fiona M Blyth, Pippy Walker, Samantha Rowbotham, Andrew Wilson. Preventing chronic pain in primary care, Australian Pain Society 38th and New Zealand Pain Society Conjoint Annual Scientific Meeting, Sydney NSW, April 2018, Poster presentation.

Other presentations

  • Fiona M Blyth, Simone De Morgan, Pippy Walker, Andrew Wilson. Final presentation of findings to stakeholders, June 2021. 
  • Simone De Morgan. Working with Primary Health Networks on preventing and managing chronic pain, The Australian Prevention Partnership Centre Investigators Forum, September 2020, Oral presentation
  • Simone De Morgan. Improving the secondary prevention and management of chronic pain in primary care – a focus on Primary Health Networks, The Australian Prevention Partnership Centre Investigators Forum, September 2020, Oral presentation
  • Simone De Morgan. Improving the prevention and management of chronic pain in primary care, The Australian Prevention Partnership Centre Investigators Forum, November 2018, Oral presentation