The following article is a (slightly abridged) reprint of a report by Dr Tim Semple, the President of the Australian Pain Society (APS), in the latest (December) issue of the APS Newsletter, reprinted with the author’s permission. It provides a clear demonstration of the potential for government to make a real difference to the problem of pain in society – if it accepts responsibility. Coincidently, several days after the publication of Dr Semple’s article, APMA received a copy of correspondence from the (now former) Minister for Health and Ageing the Hon Nicola Roxon to Mr Tony Windsor MP, Federal Member for New England, who had taken up APMA’s call for support for the National Pain Strategy. The contrast with the US situation – and need for a great deal of lobbying and agitation to achieve the major changes necessary – are clear. You can read the letter here. We look forward to hearing the views of the newly appointed Minister, the Hon Tanya Plibersek MP. And we also strongly urge you, APMA members and supporters, to promote the adoption of the National pain Strategy to your state and federal members of parliament.
Two particularly powerful documents have appeared from the USA in the past 18 months and I strongly recommend you take some time to review them (the links are found below). These are substantive works but well worthwhile the effort to digest their implications. The first to appear was the “Pain Management Taskforce Report” of the US Department of Defense and the Veterans Health Administration in May 2010. This provides an overview of the unmet pain needs of soldiers, veterans and their families, and was initiated in response to the overwhelming impact of pain (and failure of the health care model to manage it) arising as a sequelae of the wars in Iraq and Afghanistan. The drive for this comes from the very top – Section 711 of the National Defense Authorisation Act 2010 tasked the Secretary of Defense to develop and implement a comprehensive policy on pain management in the military health care system no later than March 31, 2011. The Taskforce Report provides a strong message selling the need for development of comprehensive multidisciplinary pain management services and more funding for pain research – despite coming from the perhaps unlikely source of the most powerful military organization in the world. The holistic model envisaged for acute and persistent/chronic pain care will be world-leading if implemented.
More recently the report of the Institute of Medicine –“Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” became available to provide direction to transforming the understanding and management of pain across the whole of health in the USA.
This document, of over 300 pages, provides cogent and powerful arguments for approaching pain as a major public health issue and one to be taken very seriously by the US government. They argue strongly that chronic pain can in some circumstances be a disease in its own right. Comprehensive chapters on the care of people with pain, and education and research challenges are included. The findings and recommendations are very similar to those proposed in the Australian National Pain Strategy. The final chapter outlines a “blueprint” for the future. The report even provides a timeline for implementing the blueprint with a significant number of initiatives to be achieved by end 2012.
With very similar broad goals and recommendations between the Australian National Pain Strategy and the US Institute of Medicine Blueprint, it is interesting to look at the differences. Unlike the situation here, the IOM Blueprint has been commissioned from the highest level of US government. The US Senate and House of Representatives amended the Public Service Act to add the National Pain Care Policy Act. The Secretary of Health and Human Services was directed to engage the Institute of Medicine to provide within one year the report that is now available and a sum of $1,000,000 was allocated by the US Congress for this purpose. In Australia……
What can we take from this? In the US the highest levels of government have recognised the overwhelming shortfalls in services for pain management and have directed the Secretary of Defense and the Secretary of Health to provide plans and blueprints to begin the process to address the problems. By the act of recognizing the need for improving pain management and asking for direction, the US government appears to have taken on ownership and accountability for making progress in this issue.
In Australia by comparison, despite the presence of Minister Roxon at the Pain Summit last year, there seems to have been little direct engagement by the Federal Department of Health and Aging. Painaustralia, in its role as our peak advocacy body, has been working hard with very limited resources to advocate on every possible issue related to pain and has achieved significant successes with, amongst others, the recent disability review and with the PBAC recommendation review. The APS itself has directly responded to Federal DOHA on an increasing number of pain-related issues (as has the Faculty of Pain Medicine and the consumer organisations the Australian Pain Management Association and CPA). The profile of pain management in Australia does appear to be rising albeit slowly and very much as a bottom-up process.
Significant progress has been made in palliative medicine over the last decade. It is now eleven years since the Commonwealth Department of Heath and Aged Care released the “National Palliative Care Strategy A National Framework for Palliative Care Service Development” and this strategy was further updated in 2010. It is now time for the Australian government to acknowledge the unmet needs of the Australians with persistent (chronic) pain.
Getting attention from our federal funding organisations requires much patience and hard work. APS members, can make a difference by bringing the National Pain Strategy to the attention of your local federal member. State members of parliament should be lobbied too. Some of our state health departments have responded to the evidence: the current activities in Queensland, WA and NSW are encouraging. The work of the APS Executive will be tremendously enhanced if you, the APS members, promote the National Pain Strategy to your state and federal members of parliament.