Preventing the development of chronic pain
Project title: Strategies and models for preventing or reducing the risk of the development of chronic pain in primary care
Start date: February 2018
Estimated end date: July 2020
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.
There is evidence that 80% of people with chronic non-cancer pain could be treated effectively if they could access appropriate services. 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. Less than 10% of people with chronic non-cancer pain gain access to effective care.
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 is the project addressing the issue?
This project focuses on strategies to improve pain management in primary care. It aims to prevent progression to disabling chronic pain, and 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 concentrates 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.
The project will clarify the evidence for prevention and early intervention. We will develop with stakeholders a set of evidence-based principles and use these to assess models of intervention that could work in the Australian primary care environment, along with their resource requirements. This information will then be used to develop a tool for Primary Health Networks (PHN) to determine local capacity for prevention and early intervention and to assess the local relevance of different models. It will also help identify gaps in current service capacity including pathways to specialist care. The tool will be developed in association with and piloted in at least one PHN.
Relevance for practice
The project will identify models of early intervention that work for prevention of chronic disabling pain in primary care. It will develop a tool for PHNs to assess which models are most appropriate to local contexts, and which resources are required.
What are the expected outcomes?
- A set of evidence-informed strategies for preventing or reducing risk of chronic pain, including an estimation of likely impact relative to resources
- A set of evidence-informed consensus principles for selecting interventions for Australian settings
- A tool for capacity assessment and model(s) selection for use at PHN level
- Report on field testing of tool
- An options paper on implementing and scaling up of models for chronic pain.
Professor Fiona Blyth AM, University of Sydney
Professor Andrew Wilson, Director, The Australian Prevention Partnership Centre
Dr Samantha Rowbotham, University of Sydney
Ms Pippy Walker, The Australian Prevention Partnership Centre
Simone De Morgan, 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.
- The project steering group consists of 20 members including researchers, clinicians, Primary Health Network representatives and consumers. The first teleconference was held in January 2018 and the second teleconference in May 2018
- We have conducted a comprehensive literature review, which has identified a range of effective initiatives that work in practice and could be implemented by PHNs around Australia to improve the prevention and management of chronic pain
- We have reviewed recent PHN Needs Assessments to understand their health and service needs related to chronic pain. We found two thirds of PHNs identified chronic pain as an important issue, but only one quarter described key issues or proposed strategies to address it. None of these strategies related to the prevention of chronic pain
- We are consulting with PHNs to understand their needs and priorities related to chronic pain.
- The next steps are to communicate our findings to the PHNs to increase their awareness of opportunities for prevention and management of chronic pain. We will then work with two PHNs to help them decide on the most appropriate chronic pain initiative to implement in their area
- Poster presentation at the Australian Pain Society Meeting, Sydney, 9 April 2018
- Pippy Walker presented at the Menzies Centre Emerging Health Policy Research Conference, University of Sydney, 26 July 2018.
Prevention Centre news
- February 2018, Minister launches project to tackle chronic pain
Australian Pain Society Newsletter