Increased pain management support for GPs and patients

Amanda Lyons

18/06/2019 3:44:08 PM

The National Strategic Action Plan for Pain Management offers a boost in training for GPs, as well as additional funding support through Medicare.

National Strategic Action Plan for Pain Management
The National Strategic Action Plan for Pain Management offers a coordinated nationwide approach to chronic pain, as well as additional training and support for GPs and other health professionals.

The Department of Health this week released the National strategic action plan for pain management (the plan), outlining the blueprint for a three-year plan to address the issues faced by the 3.24 million Australians experiencing chronic pain.
As a part of this mission, there is a strong focus on education and support for GPs.
‘What we are really seeking is better training and education for GPs, and better options for GPs for referral to allied health specialists like psychologists, physiotherapists [and] nutritionists, which is really best practice care for people with pain conditions,’ Carol Bennett, Chief Executive of Painaustralia, the peak national body behind the plan’s development, told 4BC Drive.
The plan’s focus on GPs is extremely pertinent, as one in five GP consultations involve patients experiencing issues with pain.
‘As providers of day-to-day care to the community, GPs are right on the frontline of pain management,’ RACGP President, Dr Harry Nespolon, told newsGP.
‘The RACGP welcomes additional training and resourcing for GPs in this area and is supportive of the new strategic plan.’
The plan suggests a broad, overarching national education strategy and assessment model for health professionals, based a biopsychosocial or sociopsychobiomedical framework. This education will be supported by national clinical guidelines on pain for health providers.
It also recommends additional, targeted funding through the Medicare Benefits Schedule (MBS). For example, the introduction of an MBS item specific to GPs who have a specialist qualification in pain medicine as a Fellow of the Faculty of Pain Medicine.
Also recommended is the recognition of pain as a complex condition that is eligible for a Medicare supported pain management plan, offering access to 10 individual services and 10 group services per calendar year.
Dr Milana Votrubec, Chair of the RACGP Pain Management Specific Interests network, supports the concept of more pain management education for GPs, and in favour of any initiative that may allow them to spend extra time with patients on these issues, as their needs are often complex.
‘You have to allocate the time. Just as you allocate time for a patient who’s got complex health issues, pain is no different,’ Dr Votrubec told newsGP.
‘The take-home message for GPs has to be the ability to spend the time with that patient … take the time to hear their patient’s pain story in order to focus on achievable goals.’
Another focus of the plan is reduction of patient reliance on opioids and other forms of pain medication, with an emphasis instead on treatment options such as exercise and psychology.
Dr Nespolon agrees that reducing dependence on medication is a positive move for patients.
‘While the desire for a simple treatment option in the form of a pill is understandable, we now know that opioids and other forms of medication can end up being more harmful than helpful,’ he said.
‘Prescribing medications still remains an important part of pain management for the appropriate patient, but non-drug treatments such as physical exercise as part of a comprehensive care plan are often more effective and have more lasting positive effects on a patient’s quality of life.’
The plan must be endorsed by the state and territory health ministers before it can be implemented.
Ms Bennett believes that if pain management processes do not change, there will be significant consequences for Australia – not least, financially, with the costs of chronic pain estimated at $139.3 billion per year and projected to rise to $205.6 billion by 2050.
‘That increase will happen if we don’t do something about this issue,’ she said. ‘We know it has this huge cost impost in health, in social, in economic terms. So we can’t afford to do nothing about this.’
Dr Votrubec is hopeful that a coordinated national response to pain management will be put into place and that it will herald a change in the way health professionals are trained to manage the issue.
‘[We need] to direct our attention to the patient as much as to the GP, and have a groundswell of people who are cognisant of chronic pain not indicating harm as much as it is causing them psychological harm,’ she said.

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Darren Emerick   19/06/2019 1:39:05 PM

There are new products that general practitioners can supervise. Ketamine Interval Therapy for patients with chronic pain and depressive disorders. Ketamine and a codrug which diminishes complications can be given by nasal spray and the patient is monitored in the clinic for 3-4hours.
Single treatments can improve pain and depression for up to 14 days.
GD Pharma Adelaide.

Mrs Christine Radford   19/06/2019 4:52:56 PM

I well remember the RACGP when they went on television espousing the reasons for removing the over the counter low dose codeine products. Except, they were not telling the whole truth were they? Their line was that these products were being removed because of the death rate. What they didn't tell us was that 99.9% of deaths were caused by prescription medication NOT over the counter products. Now we must beg our GP for pain assistance but can buy ICE and other similar products at liberty anywhere. It is no surprise that prescription rates have soared. It is hardly rocket science. It seems we, the little people, are about to become the victims of yet another turf war.

Kenneth Hamilton   19/06/2019 4:56:26 PM

I'd like to learn more.

Susan   20/06/2019 11:09:38 AM

This is a cruel measure to save a few dollars. Shame on you pain Australia...shame.

John   22/06/2019 8:10:01 AM

I work in regional NSW. Patients who suffer from chronic pain are mostly unemployed or work minimum hours. Access to psychologists and physiotherapists is costly which is why very few agree to see them. Even on a chronic disease care plan, they are required to pay a gap every visit. Medications turn out to be the easier and cheaper option to them. Accessibility to these allied health care workers is key.

Dr Bill Meyers   22/06/2019 9:31:42 AM

Why not use the funding to improve Medicare rebates for Medical Acupuncture and remove the financial penalties for patients wishing to access Level 1 Evidence Based treatment for chronic pain? Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2.
Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.
Vickers AJ1

Edwin Pragasam   22/06/2019 3:17:21 PM

Well done ! Long overdue. Hopefully it will be in practice soon.

Simon Holliday   23/06/2019 5:05:20 PM

There is some excellent material in this plan. However, as was the Deloitte report "The Cost of Pain" it is primarily viewing pain management from the specialist pain service level eg specialist services need more funding, GPs need more qualifications in specialist care and GP training needs to be developed by specialist providers. General Practice care is regarded as "control care" for research, as Treatment as Usual.
The problem about this is that currently 0.2% of chronic pain is managed by specialist pain services. They have a niche service which is resourced at a totally different level to General Practice. General practitioners deal with pain all day, but there are usually several problems being managed as chronic pain comes with high rates of chronic multimorbidities.
Improving pain care is possible. Generalists, GPs and Allied Health Providers, need to lead this, in conversation with the niche experts to make it accessible and affordable.

Dr Brian Ernest Cole   27/06/2019 2:22:38 PM

Access to Specialist pain management is by and large a privilege of the urban middle class and above.
I have often found the advice offered when I have accessed a public clinic to be impractical.
There are some very helpful pain specialists and clinics e.g. Albury Wodonga.
There are some that are not so helpful.
The connection with mental health services is not good and the Mental Health Items are often not helpful. Long way to go. Someone to talk to about difficult cases would be good.

Dr Mark Frederick Fletcher   29/06/2019 12:01:56 AM

I send patients to chronic pain specialists from time to time. Most of these patients are complex, as you would imagine. Most of the time, the patient comes back on a different opiate regime than what they went in on, now feeling worse and their pain is no better. I don't blame the pain specialists, they have few to no other options. Patronising doctors about non-pharmacological benefits to chronic pain as an alternative to opiates is mostly rubbish. Whilst useful, exercise and physical, non pharmacological treatments will help patients who are in mild to moderate pain. The patients in more severe chronic pain will still need opiates along with everything else. Until someone finds a better alternative then I'm not interested. A few people have mentioned ketamine and there is some good evidence for its use in both acute and chronic pain, opiate dependence and severe depression but from my experience, it has always been short lived and within a few months, the patient is back on opiates.