Preventing the development of chronic pain

What is the issue?

• Chronic non-cancer pain is a major public health issue and has been classified as a disease in itself through the World Health Organization.
• Chronic pain affects approximately one in five people in Australia and is increasing due to the ageing population.
• Chronic pain can lead to poorer quality of life, depression and anxiety, loss of income and premature retirement, and create feelings of stigmatisation and exclusion.
• The total economic cost of chronic pain in Australia is high, estimated as A$139 billion in 2018, through reduced quality of life, productivity losses and direct health system costs.
• Tertiary pain services have long waiting lists and are unable to meet increasing demand.
• Primary care is a crucial intervention point to improve access to multidisciplinary pain care

How did our project address the issue?

• Our project focused on Australia Primary Health Networks (PHNs) given their remit to support primary care and to commission services to address local needs.
• The project had two overall aims:
  1. To synthesise knowledge about the secondary prevention and management of chronic pain
  2. To improve knowledge, knowledge-sharing and knowledge use among PHNs about options to address the secondary prevention and management of chronic pain in primary care
• We had a high level of engagement with PHNs, consulting with executive level staff and program leaders from most PHNs across Australia

The project had three phases, outlined below.

Phase 1 – needs, priorities and gaps related to chronic pain

• A review of publicly available core PHN Needs Assessments
• Consultation (via telephone interviews and online surveys) with PHNs to understand their needs, priorities and gaps related to chronic pain
• Mapping of PHN chronic pain initiatives
• Workshop with PHNs to discuss chronic pain initiatives

Phase 2 – secondary prevention of chronic pain

• A deliberative dialogue with PHNs about options to address the secondary prevention of chronic pain informed by a rapid evidence review

Phase 3 – community-based pain programs

• eDelphi survey of experts to establish consensus on the key elements and enablers to implementation of community-based pain programs
• Online survey and consultation (via email) of PHNs about the features of their community-based pain programs; and program adaptations during the COVID-19 pandemic

What were the outcomes?

• A scoping literature review to identify the evidence related to the secondary prevention and management of chronic pain in primary care in Australia
• Understanding the needs and priorities of PHNs related to the secondary prevention and management of chronic pain in primary care
• Improving knowledge among PHN decision-makers about chronic pain and options to address the secondary prevention and management of chronic pain
• Mapping current PHN chronic pain initiatives and identifying gaps
• Identifying two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain)
• Highlighting key enablers to implementation of PHN chronic pain initiatives
• Highlighting solutions identified by PHNs to increase capacity to commission initiatives

What is the relevance for policy and practice?

• PHNs could do more to improve the secondary prevention and management of chronic pain
• A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity
• Exemplar evidence-based initiatives to improve the secondary prevention and management of chronic pain could be scaled-up across PHNs in Australia