‘Getting Back on their Feet’
The NSW Liberals & Nationals Plan for Pain Management
"Pain is one of the biggest health issues in Australia today – every bit as big as cancer,
AIDS and coronary heart disease. Yet it remains one of the most neglected areas of healthcare."
Professor Michael Cousins AM
Chair, National Pain Strategy and Director, Painaustralia.
The NSW Liberals & Nationals understand the importance of providing relief for the
thousands of people whose lives are limited because of their chronic pain.
Persistent pain is the third most prevalent health condition in Australia costing in excess of
$34 billion to the Australian economy. It is estimated that approximately 3.2 million
Australians suffer persistent (or chronic) pain and 30 per cent of these people have severe
pain-related disability. The number of severely disabled pain sufferers in New South Wales
is estimated to be at least 300,000.1
A review of pain services across Australia has found many people suffering from persistent
pain, so called because it persists beyond the normal healing time of about three months,
are unable to access pain treatment."2
This can have a huge impact in terms of quality of life, capacity to work and undertake daily
activities as well as the financial costs to the individual, their families and society as a whole.
Whilst excellent work is being done in pain management, there is no cohesive plan for
current or future service demand and provision across NSW.
The NSW Liberals & Nationals plan for Pain Management includes the following two
strategies:
1. Develop a state-wide NSW Pain Management Plan in consultation with pain
management experts and patients, including members of the National Pain
Strategy. The plan will include initiatives to better document:
a. the extent of prevalence of pain in NSW,
b. research to indicate most effective interventions,
c. the resource needs of the nine dedicated, and Faculty of Pain Management
approved, pain clinics across NSW to ensure they are able to meet demand
and address long waiting times for treatment, and
d. strategies, including initiatives of the NSW Agency for Clinical Innovation in
extending links between specialist pain clinics and primary care settings, that
are aimed at giving patients a smoother pathway between community based
primary health care and hospital based services and keeping people out of
unnecessary hospitalisation - a plan strongly in keeping with the National Pain
Strategy.
1
Access Economics, 2007, The High Price of Pain: the economic impact of persistent pain in Australia. p iii
The Australian Pain Society. 2010. 'Waiting in pain: a systematic investigation into the [provision of persistent pain
services in Australia.' Interim report. p. 9
2
2. Maintain existing programs across NSW which assist people who have persistent
and difficult to manage severe pain, for example the ADAPT – Active day Patient –
and associated programs which have earned world-wide acclaim for results in getting
patients, often bed-ridden, back on their feet and back to work. 3
ADAPT is provided by the Royal North Shore Hospital Pain Management Research
Centre led by Professor Michael Cousins who heads a team of medical and other
healthcare professionals and scientists involved in basic and clinical research as well as
providing education and training for pain professionals which are now available in 20
countries..
Access to Pain Relief has also been recognised as a fundamental human right by the
International Association for the Study of Pain. This is articulated in the Declaration of
Montreal released following the 2010 International Pain Summit in Canada, Chaired by
Professor Cousins (refer to www.painaustralia.org.au).
3
See patient stories on http://www.pmri.med.usyd.edu.au/stories/index.php
Getting back on her feet – a patient’s story
Aletha Weir, 34 has suffered from the chronic pain condition Occipital Neuralgia for the past
9 years. This is her story:
In 2002, a small bone osteoma started to grow at the back of my head on the right side,
causing me minimal discomfort. In 2008, it started to slowly grow again and I began to
experience various amounts of pain directly over the bony lump. By November 2008, the
pain that would generally last for 20mins at a time had become very severe and I would
have up to 30 episodes in a day. I had the lump and any actively growing bone removed in
November 2008. During the operation doctors discovered that the lump had grown
underneath my greater occipital nerve, the nerve had been badly stretched and damaged by
the growth. During the operation, the nerve was exposed and held away from the site so the
surgeon could grind and remove the bony mass.
Over 2009 the pain continued intermittently in varying severity, I trialled various medications
and treatment methods to no avail. I continued to work full time as a special education
teacher, but I stopped playing sport and had to limit social activity with friends and family.
I gave up full time work in April of 2010 as the pain became too much to bear and limited my
ability to function at work safely and effectively and at times even look after myself. I had to
move in with family members as I needed care on a daily basis and financially I could not
maintain my independent life style.
In August 2009, I was assessed by the team at the Pain Management Research Centre
(PMRC), University of Sydney, Royal North Shore Hospital.
Later in, 2010 I had an occipital neuro-stimulator implanted at the PMRC by Professor
Michael Cousins. The stimulator has been effective in relieving 50 -60% of my pain.
I also attended the ADAPT Pain Management program at the clinic in January this year. I
can still experience severe pain some days and I am learning to manage the pain that
remains to the best of my ability. I have returned to work one a day a week with varying
success in 2011.
Professor Michael Cousins: Aletha was a fit, active young woman with an important job
teaching children with special needs. But by the time I saw her at the PMRC, chronic severe
neuropathic pain, caused by a damaged occipital nerve had taken its toll. She was unable to
work and her normal daily activities were severely limited. In brief, her quality of life was at
rock bottom and she was unable to find her way out of this downward spiral.
Following assessment by a multi-disciplinary team, Aletha underwent a procedure to implant
a sub- occipital neuro-stimulator which targets the neuroplastic changes in the brain which
caused her persistent pain. It did this by sending electronic impulses into the brain via the
occipital nerves which in turn releases a brain transmitter known to inhibit pain.
Aletha also attended the ADAPT Program - an intensive 3 week course which enables
patients to self-manage their pain through a range of techniques which include Cognitive
Behavioural Therapy (CBT). This helps them regain lost physical and mental abilities which
in turn relieves the impact of pain upon them.
In another six months, without these interventions, Aletha’s condition may have become
irreversible. She may never have worked again, and this would have been a very real loss to
the community. Aletha’s experience highlights the need for multi-disciplinary pain
assessment and treatment to be accessible to people in need, often within a very critical
timeframe.