3rd April 2014.
Opening Statement to the Joint Committee on Health and Children for the
Meeting to be held on the 10th April 2014 in Committee Room 2.
The Republic of Ireland has a population of 4.65m of which 13% (604,500) are living with Chronic
Pain. Of that cohort 20% (120,900) are living with persistent daily pain at a severe to very severe
level. (See statistics Appendix 1). The impact of living with such pain is devastating on the individual,
their immediate family and on their relationships with friends and colleagues. It leads to isolation,
loneliness and in many cases end of life thoughts. Chronic Pain Ireland (CPI) is the sole National
organisation providing information and support to those living with Chronic Pain. Our main work is
the provision of Self Care workshops for those living with Chronic Pain. Through the implementation
of various strategies we help people to cope better with their pain and in many cases reduce the pain
sensation level. These positive aspects of our Self Care Strategies reduces the number of GP visits,
consultations with the Pain Specialists and in many cases leads to a reduction in the use of
medications. We also provide services to other organisations whose members have long term medical
conditions. In the UK these services are provided in the community by local authorities and we have a
significant amount of documentary evidence backing up the benefits of Self Care,.
The provision of services for those living with Chronic Pain in Ireland lags behind most European
countries and thanks, mainly to the dedicated work of some healthcare professionals that minimal
services do exist in Ireland. However there are no agreed systems, structures or protocols for the
diagnosis, treatment and management of Chronic Pain in any of the four HSE areas.
We are aware that Consultant Anaesthetists who specialise in the diagnosis, treatment and
management of Chronic Pain have through their organisation, The Irish Pain Clinicians Network,
(IPCN) made an application to the Irish Medical Council (IMC) to have Chronic Pain declared a
Medical Specialty. We have supported that application and sought a meeting with the Minister for
Health & Children, Dr James Reilly TD to seek his support. At that meeting he stated he would not go
as far as to declare Chronic Pain a disease in its own right but would have no issue with declaring it a
medical specialty if the IMC made such a recommendation. It is our understanding that the IMC have
made that recommendation to the Minister and we await hearing from the Minister
It is over eight years since the following declaration was made and very little has happened since.
“The Relief of Pain should be declared a fundamental human right as per the central theme adopted
by IASP, EFIC and the WHO at a conference in Geneva on the 11th October 2004.”
However we are encouraged by the work being undertaken in the UK, Australia, Spain, Belgium and
also in the US and New Zealand. The Medical Council of New Zealand declared Pain Medicine a
Medical Specialty in December 2012 which brings it in line with Australia. (See press release
Appendix 2)
In most Scandinavian countries you will be automatically referred to a Pain Consultant if your pain
has lasted more than three months. (Medical definition of Chronic Pain is Pain that lasts more than
three months which is considered the maximum time for healing in relation to acute pain.)In Ireland
you will in all probability be referred to many healthcare professionals before eventually being
referred to a ‘Pain Consultant’ as a last desperate resort. The result is an enormous waste of
valuable and expensive health resources and the rapid ramping up of the patient’s pain chronicity
with the consequential long term effects; including loss of employment, financial difficulties,
emotional problems as well as isolation and loneliness. Some at this stage will end up being referred
to Mental Health services at significant greater cost to the state than would have been the case if
the patient had received the correct treatment.
A National Pain Audit has been completed in England (www.nationalpainaudit.org) and outlines the
services available in each healthcare area. Scotland and Wales have done something similar with the
Minister for Health in Scotland requesting all local authorities to ensure that Self Care services are
provided for people living with Chronic Pain. The Ministry of Health in the North of Ireland in
conjunction with the Pain Association of NI are developing a National Pain Strategy. There is an
urgent need to develop a National Pain Strategy for the Republic of Ireland. However there is no
point embarking on the development of a National Strategy until such time as pain Medicine is at
the very least, recognised as a Medical Specialty.
Such a recognition or declaration would have a very positive impact on the creating of a greater
awareness of the condition of Chronic Pain among all members of the public as well as healthcare
professionals and in particular on the education of upcoming healthcare professionals. Our six
Medical Schools would have to develop modules on pain medicine and under graduates could then
decide to specialise in Pain Medicine. At present Veterinary Students spend 5 hours on Pain control
in animals for every one hour medical students spend on Pain Control in humans.
Chronic Pain costs the Irish Economy more than the costs of cancer and diabetes combined. The
problem today is that the Department of Health and the HSE see any new approach to dealing with a
new serious issue as a drain on financial resources and not as an opportunity to save money. On
average our members have been to see seven consultants/specialists before arriving at the correct
destination. What a waste of resources and what a cost to the health budget!! Proper Self Care for
any long term condition can reduce medication costs. (Prof. Irene Treacy, Radcliffe Hospital, Oxford)
What we in Chronic Pain Ireland would like is that you as members of the Joint Health Committee
would report to the Minister on this issue and convince him that his department could save
significant financial resources by dealing with this issue in an appropriate manner. Neither we or the
consultants who specialise in the diagnosis and treatment of chronic pain expect financial resources
to be thrown at this problem. We are hoping that all will have the vision to see the savings that
could be made by approaching the issue correctly and the benefits of working together in the
interests of the patient.
Thank You
John Lindsay
Chairperson
Chronic Pain Ireland
087 2390120
Appendix 1
Statistics
13% of the Irish Population is living with Chronic Pain. European Average 19%. Of the 13%,
one in five (20%) suffer from moderate to severe Chronic Pain. (Brevik H. et al 2006).
One in three respondents in the PRIME Study (McGuire B et al 2010) indicated that they
were living with Chronic Pain.
29% of people with Chronic Pain cannot work because of their condition.
42% of people with Chronic Pain think that others doubt the existence of their pain.
21% stated that the pain was so intense they wanted to die.
In the PRIME study 2% of those without chronic pain reported clinically significant levels of
depression. However in chronic pain sufferers this rose to 15%.
The average cost to the economy is €5,665 per person per annum. However at the severe
level it is €10, 454 per person per annum.
(McGuire B et al NUIG 2010)
Chronic Pain costs the Irish economy 2.55% of GDP (€4.76b per annum)
(Prof. Charles Normand TCD 2010)
Appendix 2
Friday November 2, 2012
Pain medicine recognition great news for those in pain
Up to one in five New Zealanders estimated to suffer from chronic pain will be the big winners of a
Medical Council of New Zealand decision to recognise pain medicine as a specialty in its own right,
say pain medicine specialists.
The Medical Council has accredited pain medicine as a scope of practice In New Zealand, giving
formal recognition to this medical specialty and its associated qualification. The new scope and
qualification come into effect on December 3 this year. The accreditation follows a lengthy
application process undertaken by the Faculty of Pain Medicine (FPM) of the Australian and New
Zealand College of Anaesthetists.
“This keenly awaited decision recognises the importance of pain medicine as a field requiring
specialised skills and qualities to address the epidemic of people suffering in pain in our
communities,” FPM Dean Associate Professor Brendan Moore says. “Pain medicine emphasises a
holistic, all-encompassing approach to the management of pain including the physical, psychological
and emotional consequences of this common but poorly understood and under-treated medical
problem.
“This puts the practice of pain medicine in New Zealand on the same footing as in Australia, where it
has been recognised as a stand-alone specialist qualification since 2005. There is now a single unified
training and accreditation system, and qualification, for recognising pain medicine specialist
physicians across Australia and New Zealand.
“Australian and New Zealand specialists with backgrounds in anaesthesia, surgery, rehabilitation
medicine, psychiatry and general medicine have worked together for 15 years to establish and
progress the training, examination and continuing professional development of pain medicine
specialists.
“The Medical Council’s decision recognises these achievements and the expertise of New Zealand
specialists who have contributed to the development of this specialty in New Zealand, Australia and
internationally. Both our immediate past dean and current vice dean are New Zealanders,” Associate
Professor Moore says.
FPM Vice Dean, Professor Ted Shipton of Christchurch, says that while New Zealand already has
some pain medicine specialists, lack of formal Medical Council accreditation has limited
development of the specialty.
“We expect this recognition to lead to a growth of interest in the specialty and more training places
opening up here in New Zealand, where such specialists are desperately needed.”
Professor Shipton says pain is the most common reason for patients consulting health care
professionals.
“Data from the 2006/07 New Zealand Health Survey showed that one in six New Zealanders (16.9%)
suffered from chronic pain with other estimates putting the figure at about 20 per cent, an incidence
that is even higher among the elderly. This makes chronic pain – which has a profound effect on the
sufferer, their family and society as a whole – a critical public health problem in New Zealand.
“The proper management of pain remains one of the most important obligations of a physician.
Acute pain has a warning or protective function but, if not managed properly, it becomes chronic
pain,” Professor Shipton explains.
“We can now look forward to better care of all New Zealanders who suffer from pain, provided the
Ministry of Health and district health boards pick up the challenge to adequately resource and
expand acute and chronic pain management services in New Zealand.”
ENDS
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