Living well with persistent pain

Thursday, November 19, 2015

Chronic pain services in South Australia are limited. They are predominantly based within tertiary organisations which are struggling to meet the changing needs of the population with their current level of resources. Data around the impact of chronic pain in the Adelaide region are difficult to find, however the most recent prevalence was put at 18%. This suggests a figure of 250,000 South Australians living with chronic pain, with 70,000 requiring input from a tertiary service. SA Health acknowledges the waiting time to access tertiary pain services are the longest in the country. This leads to a situation where approximately 80% of South Australians living with chronic pain are not receiving treatment and support which could improve their health and quality of life

Best practice models of care for pain management set out that patients of lowto-medium complexity should be managed within the primary care sector. However, chronic pain management is often seen by general practice as “not rewarding” and “too time- and resource-consuming”. This means people living with chronic pain may experience stigma and other difficulties trying to access pain management in their local community.

Recognition of the level of services providing pain management options in primary care in northern Adelaide led to the implementation of the PainWISE® program, Living Well with Persistent Pain. The program was enacted by the Northern Adelaide Medicare Local in partnership with Elizabeth Family Health, the Northern Adelaide Local Health Network (NAHLN) and the Royal Adelaide Hospital Pain Management Unit (RAH PMU). Living Well with Persistent Pain is now being delivered by the Northern Health Network, with funding provided by the Adelaide Primary Health Network.

The use of pain clinics and programs is well supported in the literature as an important part of pain management. Treatment often starts with an initial assessment by a care coordinator and goes on to involve a multidisciplinary team, including a GP, all of whom support the person with an individualised plan for coordinated management of pain. This could include diagnostic assessments, physical therapies, behavioural techniques and medication management.

Living Well with Persistent Pain is such a program. Based on the successful Gold Coast PainWISE® program Turning Pain into Gain, it combines primary care services and self-management strategies. Together, these support individuals to better understand their pain condition and equip them with the necessary tools to improve their quality of life. This then minimises the burden of pain on them, their families and the wider community. The program focuses on people currently waiting for tertiary pain management services, aiming to provide an accessible, local, patient-centred alternative.

Although still in a pilot phase, the 8-10 month program currently provides support for 40 participants through a holistic selfmanagement course, case coordination and extended allied health services. A GP with a particular interest in managing persistent pain is also available for access. A care coordinator undertakes an initial assessment and supports the patient and GP through the process of both group sessions and one-onone allied health services with providers, including an accredited pharmacist, dietitian, exercise physiologist, plus physiotherapists and psychologists.

Self-management support is at the heart of Living Well with Persistent Pain. Both the education sessions and the individual care plan are centred on the concept that the patient is best placed to determine their own pain-management pathway. The individual assessment is structured in a way that assists the patient to identify their own life-based goals. The education sessions support the individual plan by providing a wide range of self-care options and links. The sessions are also a forum for participants to share their thoughts and experiences with others. Participants are actively attending both the group sessions and working on their individual treatment plans with the health team. Many of them report better understanding about how their pain responds to their thoughts and actions and are endeavouring to put this new knowledge into practical strategies for change.

The Adelaide Primary Health Network and the Northern Health Network together feel that Living Well with Persistent Pain represents an opportunity to better support individuals experiencing chronic pain, in an innovative and efficient way. Future plans for the program include a second intake for northern Adelaide and also potential expansion to other areas in need of primary care pain management services.

This article was written by Adelaide Primary Health Network Chronic Disease Liaison Officer Jane Goode for The Health Advocate. To access the full publication online, click here.