Q1 Suggested objectives of the Fund

APMA supports the proposed objective of the fund, subject to the qualification that persistent (or chronic) pain needs to be explicitly recognised as a chronic disease, for the purposes of the Chronic Disease Prevention and Service Improvement Fund and a range of policies including the National Chronic Disease Strategy and the National Primary Health Care Strategy.

APMA suggests that the dot points be re-ordered as follows:

• Support best practice in the prevention, detection, treatment and management of chronic disease;
• Maximise the wellbeing and quality of life of individuals affected by chronic disease;
• Reduce the pressure on the health and hospital system including aged care; and
• Reduce the incidence of preventable mortality and morbidity.

We would also suggest that the expression ‘best practice in the’ in the first dot point above be replaced by ‘evidence-based’

The failure to recognise persistent pain as a disease in its own right, and one clearly sharing the characteristics of other diseases addressed via the approaches and principles identified in the avenues National Chronic Disease Strategy, has caused a significant deficiencies in the understanding, services and evidence-base of pain management in Australia.

A large body of basic research indicates that persistent pain is associated with neuroplastic changes in the nervous system at peripheral, spinal cord and brain levels. Thus persistent pain is shown to have a distinct pathology that often worsens over time, and constitutes a serious separate disease entity.

Almost two-thirds of people with chronic pain report interference with daily activities including sleep, sex, work, exercise and routine self-care. Such interference may vary from day to day, so that people with persistent pain may cope well one day and be incapacitated by their condition the next day.

This leads to persistent pain commonly being linked to emotional distress and serious mental health problems, including depression. More details on the science of pain as a disease are included in the National Pain Strategy and the recent report from the National Academy of Sciences, Institute of Medicine in the USA titled:  Relieving Pain in America: A Blueprint for Transforming Prevention, Care, education and Research.

In addition, the European Chapter of the International Association for the Study of Pain has formally recognised persistent pain as a chronic disease and recommended that this be formally adopted by the European Parliament.

Q2 Suggested Key principles

APMA supports the proposed overarching principles of the fund.

Q3 Suggested priority Funding areas

APMA supports the proposed priority areas. As identified in 1 above, the omission of persistent pain as a chronic disease and priority has left a legacy of serious deficiencies in understanding of the disease (especially at the primary level of health care and within the community), specialist pain management services characterised by excessive waiting times which worsen the chronicity and severity of the persistent pain, and virtually no community-based support services – despite Access Economics in 2007 estimating that persistent pain costs the Australian economy $34 billion per annum and is Australia’s third most costly health problem (The High Price of Pain: The economic impact of persistent pain in Australia).  As the population ages the numbers and costs will only increase unless targeted as a priority by health systems, including this Fund. The projected increase in total numbers is expected to be from around 3.2 million to 5 million people by 2050.

Q5 Other relevant information

There is a wealth of information about the deficiencies in the management of persistent pain in Australia. APMA has strongly endorsed the National Pain Strategy, developed by over 150 health care, consumer and other stakeholder organisations at a National Pain Summit held in March 2010, officially opened by the Minister for Health and Ageing the Hon Nicola Roxon. The National Pain Strategy is a comprehensive policy initiative which sets out to improve the assessment and treatment of all forms of pain. The first goal of the Strategy is to make people in pain a national health priority, whereby federal and state governments recognise persistent pain as a chronic disease in its own right.

In addition to the National Pain Strategy, the Access Economics 2007 report The High Price of Pain: The economic impact of persistent pain in Australia is a comprehensive examination of the area. Both documents contain a wealth of information and evidence in relation to persistent pain, deficiencies in services and programs and the implications and costs of these deficiencies.

Australian Pain Management Association Inc. (APMA)

28 September 2011