Preventing the development of chronic pain
Project title: Preventing and better managing chronic pain in primary care
Start date: January 2018
Estimated end date: December 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.
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 is the project addressing the issue?
The project focuses on initiatives to improve the prevention and management of chronic pain in primary care. It aims to prevent acute pain from becoming chronic pain (e.g. post surgery or post-trauma pain) and to better manage chronic pain to prevent the progression to disabling chronic pain. It also aims 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.
This project focuses on Primary Health Networks (PHNs) as they serve as important levers as commissioning bodies and supporters of primary health care services.
The aims of the project are to:
- Synthesise 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
- Understand the needs and priorities of PHNs related to the prevention and management of chronic pain in primary care
- Understand the scope of work currently being undertaken and commissioned by the PHNs related to the prevention and management of chronic pain in primary care and identify gaps
- Understand the barriers and enablers for PHNs to implementing and sustaining initiatives to improve the prevention and management of chronic pain
- Improve the knowledge of PHNs of 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)
- Foster collaboration and partnership between PHNs about initiatives related to chronic pain
- Improve PHNs understanding of good implementation and evaluation and the keys aspects to consider when delivering and commissioning out initiatives
- Using one-three PHNs as a demonstration, assist PHNs in developing an implementation and evaluation plan of their selected chronic pain initiative considering their local barriers and enablers to implementation and their evaluation capacity.
Relevance for practice
The project will develop communication tools and conduct 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.
What are the expected outcomes?
- A scoping literature review to identify the evidence related to the prevention and management of chronic pain in primary care
- A review of PHN recent Needs Assessments
- A report of PHN consultations about their priorities and the chronic pain initiatives PHNs are currently implementing
- Mapping of PHN chronic pain initiatives communication tool
- Mapping of online and easily accessible chronic pain initiatives and resources communication tool, available here
- A workshop with PHNs about their chronic pain initiatives
- A workshop with PHNs about implementation, continuous improvement and evaluation
- Using one-three PHNs as a demonstration, assist PHNs in developing an implementation and evaluation plan of their selected chronic pain initiative considering their local barriers and enablers to implementation and their evaluation capacity. PHNs will be recruited who have proposed a chronic pain initiative in their work plan and are interested in implementation and evaluation support.
Professor Fiona Blyth AM, University of Sydney
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.
- The project steering group consists of 20 members including researchers, clinicians, PHN representatives and consumers. Two teleconferences with the steering group were held in January and 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 consulted with PHNs to understand their needs and priorities related to chronic pain and then communicated our findings to the PHNs to increase their awareness of opportunities for prevention and management of chronic pain. Read the PHN chronic pain workshop summary.
- We continue to work with PHNs to help them determine the most appropriate chronic pain initiative to implement in their area.
- The project’s team members are undertaking a rapid review of the evidence and mapping current chronic pain initiatives related to the secondary prevention of chronic pain to inform the next workshop. The workshop will involve PHN decisions makers and will be held on 8 October 2019 in Sydney.
- Walker P, De Morgan S, Sanders D, Nicholas M, Blyth FM. Primary care initiatives focused on the secondary prevention and management of chronic pain: A scoping review of the Australian literature. Australian Journal of Primary Health. 2020 Jul 16. doi: 10.1071/PY20092
- Opportunities for Primary Health Networks to improve the management and secondary prevention of chronic pain, August 2020
- How to adapt your consumer pain program during COVID-19: Workshop summary of key presentations, April 2020
- Secondary prevention of chronic pain, PHN dialogue: A dialogue with Primary Health Networks, November 2019
- Secondary prevention of chronic pain: Rapid review and mapping of options for Primary Health Networks, October 2019
- Review of Primary Health Network chronic pain initiatives: Summary of findings from the consultation with Primary Health Networks, June 2019
- Chronic pain resources: A summary of online and accessible initiatives and resources, March 2019
- PHN chronic pain workshop summary: Opportunities for improving the prevention and management of chronic pain in primary care, March 2019
- Review of the Primary Health Networks Needs Assessments: Improving the prevention and management of chronic pain in primary care, September 2018
Prevention Works podcast
- Addressing chronic pain – one of our biggest health problems in Australia: In this episode, we visit Concord Repatriation General Hospital in Sydney to meet with Professor Fiona Blyth and learn about the difference between acute and chronic pain, the massive scale of the problem in Australia, and why primary care is key.
- Project team, Preventing and better managing chronic pain in primary care final project steering group presentation, 9 December 2020
- Simone De Morgan. The role of Primary Health Networks in improving the prevention and management of chronic pain in primary care at the Emerging Health Policy Research Conference, 27 June 2019.
- Simone De Morgan. Poster presentation on the Review of Primary Health Network chronic pain initiatives at the Australasian Association for Academic Primary Care (AAAPC) Conference, University of Adelaide, 12 July 2019.
- Pippy Walker. Menzies Centre Emerging Health Policy Research Conference, University of Sydney, 26 July 2018.
- Poster presentation, Australian Pain Society Meeting, Sydney, 9 April 2018
Prevention Centre news
- April 2019, New chronic pain resources for primary care
- February 2018, Minister launches project to tackle chronic pain
Australian Pain Society Newsletter
- 9 December 2020, Preventing and better managing chronic pain in primary care final project steering group presentation