The ability of people living with persistent (chronic pain) to access income support via a Disability Support Pension has been improved as a result of new Impairment Tables which came in to operation on 1 January 2012. This is of critical importance for people whose pain causes severe impairment preventing them working at least 15 hours per week.

Effective representation

Thanks to effective lobbying and representations by a range of pain stakeholder groups – APMA (representing pain patients or consumers), the Australian Pain Society and the Faculty of Pain Medicine (representing health practitioners and pain specialists) and Painaustralia (the national peak pain organisation)  – a range of concerns with the draft impairment tables recommended in June 2011 by an Advisory Committee have now been corrected by the responsible Department - Families, Housing, Community Services and Indigenous Affairs (FaHCSIA). These efforts included multiple detailed submissions to FaHCSIA and the Senate Standing Committee on Community Affairs Legislation (which held an inquiry about the legislation under which the new Tables have been issued), oral evidence to the Senate Committee at a hearing held in Melbourne in September, and workshops, face-to-face and teleconference meetings with FaHCSIA officers.

New Tables recognise chronic pain

The new Impairment Tables are contained in a legislative instrument issued by the Minister for Families, Housing, Community Services and Indigenous Affairs the Hon Jenny Macklin MP on 6 December 2011  - the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011, which are used to assess a person’s work-related impairment.  The most significant correction we achieved was recognition that chronic pain is a condition in its own right (as well as in many cases being a symptom of another condition). Subsection 6(9) deals with assessing impairment related to pain and clarifies that, where chronic pain is a fully diagnosed condition, the resulting impairment should be assessed under the Impairment Table appropriate to the bodily function affected.

Assess pain fully and appropriately

A major change strongly supported by APMA was to cease the previous practice of using a ‘miscellaneous’ table to assess pain, and instead assess the actual functional impairment arising from the pain condition (or symptom). APMA argued that this was a positive change, the effect of which – if accompanied by an insistence on comprehensive investigation and reporting by medical practitioners - would address the current inadequate treatment of people living with pain whose condition(s) are not properly investigated, diagnosed or treated. Many such individuals are simply left to languish on a disability pension without access to effective rehabilitation or employment assistance.

Inability to access best practice pain treatment not to further disadvantage people

APMA was concerned about the critical shortage of pain specialists and pain services throughout Australia, and argued that it was imperative that the Government ensured people with persistent pain could access appropriate diagnosis, assessment and treatment for their condition in a timely manner. We emphasised – in submissions to both FaHCSIA and the Senate Committee - that delays in assessment and treatment increase the severity and chronicity of persistent pain. We provided a 2010 study prepared for the National Pain Summit which identified that even where people were referred by their GP for investigation or specialist treatment, the 26 publicly funded pain facilities had a mean wait time of more than 180 days, ranging up to 575 days.

We therefore argued that additional action was required from the Government to ensure people with persistent pain could access assessment and treatment for their condition(s) in a timely manner to limit the severity and chronicity of the condition. [We also argued that the Government should encourage and require more flexibility and accommodations in Australian workplaces from employers]. The objective of assisting people to move from the Disability Support Pension (DSP) to participation in the paid workforce, wherever possible, is strongly supported by APMA. Many of our members, and other people living with pain, live in relative poverty and would love to remain in or have the opportunity to return to the workforce.

These improvements in the timeliness and accessibility of affordable pain services will take time – probably years. Given this, APMA welcomes the fact that the new Tables clarify that applicants are not prevented from being assessed as “fully diagnosed…fully treated; and …fully stabilised” as required by subsection 6(4) merely because they have been unable to access a multidisciplinary specialist pain clinic offering best practice treatment. Subsection 7 specifies (in part) that the reasonable treatment which an applicant can be required to have undertaken must be:

• available at a location reasonably accessible;
• at a reasonable cost;
• reliably expected to result in a substantial improvement in functional capacity; and
• regularly undertaken or performed.

Overhaul of Tables includes all functional effects of pain

APMA submitted that the full extent of loss of function which can be associated with persistent pain was not properly identified or assessed by the initial June draft of the tables. We argued that the Tables should be reviewed in consultation with the Faculty of Pain Medicine. Specifically, we identified effects such as loss of concentration and memory arising from severe long-term pain, inability to sleep and/or medication side-effects; the restrictions arising from severe allodynia which may restrict the ability to wear the footwear or clothing required in many occupations; and the crippling restrictions which can arise with some cases of chronic pelvic pain such as endometriosis were not clearly identified as assessable. In subsequent teleconferences involving APMA and our partner pain stakeholder groups, each of these issues was comprehensively and satisfactorily addressed. Tables 1, 7, 10 and 14 have all had pain-specific references included, and neuropathic pain can be assessed under Table 7 (brain function). All of the key issues around the assessment of pain were resolved whilst ensuring that the new Impairment Tables were consistent with contemporary medical and rehabilitation practice, in a consultative approach which other departments and governments would do well to emulate.

No targetting of existing DSP pensioners

In response to our concerns about the potential that the new Tables might be applied to existing DSP recipients with persistent pain and force people to return to work – or more likely the lower payment of a sickness benefit – and the significant anxiety this was causing current recipients, FaHCSIA agreed to a range of measures to ensure no existing recipient would lose access to the DSP unless it was clearly demonstrated that payment of the DSP was not appropriate. The FaHCSIA website emphasises that a medical review is normally brought about by changes in circumstances such as earnings, assets or updated medical information, and that there will be no additional medical reviews as a result of the new Impairment Tables. This was a critical issue for APMA, and the repeated reassurance provided by FaHCSIA in response to the concerns is very welcome.

APMA welcomes new assessment rules

APMA does not accept or support some of the hysterical predictions that people with chronic pain would be excluded from applying for or obtaining the DSP. We hoped that the new Tables would help to meet a key objective of the National Pain Strategy - that the economic cost to people with pain (and their families) of sub-optimal management of pain would be reduced – and as a result of consumers (APMA) and health practitioners (APS and FPM) working together with Painaustralia to ensure informed and evidence-based submissions were provided to government, we have been successful.

As APMA Secretary Lil Carrigan says, “APMA encourages and supports people with pain to be active partners in their health care and participate in society as fully as they can. The new Tables assess people on their ability to be part of the workforce and as a result encourage them to work to the maximum of their ability. APMA, in partnership with Painaustralia and the Australian Pain Society, is looking to dramatically expand the level of community-based support services available to assist people to self-manage their pain conditions, and to stay in or return to the workforce. We hope that other Government Departments are as supportive of people living with pain as FaHCSIA have been. But where people just can’t work, the Disability Support Pension must be and will be accessible”.

APMA will continue to closely monitor the application of the new Tables by Centrelink, and assist any member who needs advice, assistance or information. You can access the full APMA Senate submissions here. APMA Vice-President Paul Murdoch and Painaustralia Board Member Professor Milton Cohen subsequently addressed the Senate Committee in hearings held on September 6.

Note: APMA membership provides members with access to assistance with claims for Centrelink benefits and related issues (including Disability Support Pension), as well as workers’ compensation, transport accident and veterans’ compensation matters – and access to a free initial legal referral service. Join APMA and obtain advice and assistance before the matter goes off the rails… Join here