Pain management
Chronic Pain in Australia
Published May 2020
Chronic pain is common in Australia. One in 5 Australians aged 45 and over are living with persistent, ongoing pain. This pain can be disabling and stressful, making it hard for a person to work and do the things they enjoy. More people are seeing their general practitioner (GP) for chronic pain. In 2018, chronic pain cost an estimated $139 billion in Australia, mostly through reduced quality of life and productivity losses. This report provides insight into the experience of Australians managing chronic pain. It explores the latest national data on the proportion of people with chronic pain, as well as its impact, treatment and management.
Chronic Pain Australia can help you improve your knowledge and understanding about chronic pain across Australia www.chronicpainaustralia.org.au
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A recent scientific paper published in the ANZ Journal of Surgery found that patients are not provided with sufficient information when discharged from a hospital with opioids—but the Choosing Wisely 'Managing pain and opioid medicines' resource for use in hospitals is helping address this patient knowledge gap.
Opioids are a class of medicines taken to help reduce pain. They work on the central nervous system to slow down nerve signals between the brain and the body. This can reduce feelings of pain, but opioids may also produce unwanted effects, ranging from constipation to dangerous slowing down of a person’s breathing. The video aims to help people make an informed decision in partnership with their doctor about whether to start taking an opioid medicine for chronic (ongoing) non-cancer pain.
Consumer resources
NPS MedicineWise Opioid medicines and chronic non-cancer pain
NPS MedicineWise Chronic pain explained
NPS MedicineWise Pain: What is going on?
NPS MedicineWise Medicines for pain relief: what are the options
· Patient Resource – Opioids information videoPatient Resource– Opioid prescribing changes: improving safety, reducing harm - for patients
Opioid prescribing changes – improving safety, reducing harm
Living with pain can be challenging, whether it is short-term (also called acute) or an ongoing condition (also called chronic) Everyone experiences pain in a unique way. That means there is no one-size-fits-all approach to managing pain.
MANAGING PAIN AND OPIOID MEDICINES
https://www.choosingwisely.org.au/assets/CW-Patient-resource-Opioids_1.pdf
Well worth printing out so you know what to expect when you have to go into hospital. And what questions to ask.
In hospital
Pain is a common experience when you are in hospital. Talk to hospital staff about how pain is affecting you, so that they can help keep you as comfortable as possible. There are many ways to treat pain, with and without medicines such as paracetamol and ibuprofen. You have been prescribed an opioid, a type of pain medicine (eg, oxycodone, tramadol, morphine). These medicines work well for short-term pain but they have significant side effects and can be addictive.
Ask your health professional
- How long will the pain last?
- How much will this medicine reduce the pain?
- It’s important to only use opioids for the shortest time and at the lowest dose possible.
- Leaving hospital Before you leave hospital, make sure you ask your health professional these 5 questions and any others you may have.
- 1 What is causing the pain? The cause of the pain and how long it is expected to last depends on your situation.
- 2 What are the risks and benefits of this medicine? Opioids reduce pain – they won’t take the pain away completely. Any benefit needs to be weighed against potential harms. Opioids have major side effects, including the possibility of dependence and overdose.
- 3 How long should I take this medicine? Opioids should only be used for the shortest time and at the lowest dose possible. Discuss with your doctor or pharmacist when you can lower your dose or stop the medicine altogether.
- 4 Are there other ways to manage the pain? There are lots of effective and safer ways to manage pain, such as building activity slowly, gentle exercises and relaxation. Most people need to use a combination of strategies.
- 5 What is my pain management plan? Work with your health professional to develop a plan that works for you. You can use the pain management plan template over the page
Pain management plan
There are many ways you can manage pain and speed recovery. Work with your health professional to create your personal pain management plan.
Physical (body) Psychological (mind) Social (lifestyle)
¥ Build activity slowly ¥ Relaxation ¥ Stop smoking
¥ Physiotherapy ¥ Mindfulness ¥ Reduce alcohol
¥ Yoga or other gentle exercises ¥ Distraction ¥ Better sleep habits
¥ Massage ¥ Cognitive behavioural therapy (CBT) ¥ Stay socially active
¥ Heat or cold pack ¥ Healthy eating
Pain medicines
¥ Paracetamol
¥ Anti-inflammatory medicine
¥ Opioid
¥ Other
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Unrelieved chronic pain is not an inevitable consequence of ageing: The presence of pain is always abnormal.
Certain conditions that cause chronic pain are more common in the elderly.
Some of these conditions include:
- joint disease,
- osteoporosis,
- neuropathic pain,
- peripheral vascular disease,
- immobility, and
- amputations.
Low back pain
Providing reassurance, encouraging activity and reducing reliance on imaging.
It is important to not only treat symptoms of pain, but to also understand the underlying foundation of pain.
Describing your Pain: Caregivers want their person to talk to them about your pain. This helps them learn what may be causing the pain and how best to treat it. You need to tell caregivers if you have trouble hearing their questions or seeing things. Caregivers can use special tools and ways to help you better understand their questions about your pain.
Chronic pain - Frequently asked questions: https://www.health.nsw.gov.au/pharmaceutical/patients/Pages/faq-chronic-pain-consumers.aspx#bookmark12
Australians living with chronic pain would have access to up to 20 Medicare-funded services each year to help manage the condition under a new national strategy. The plan also calls for a new pain medicine certificate that would encourage doctors to prescribe fewer drugs to deal with pain, instead ordering exercise and psychological management strategies.
https://www.canberratimes.com.au/story/6219941/plan-for-australians-living-with-pain/
Doctors could get the certificate through six months of study, while a new website would be launched to educate people more broadly about managing pain without drugs. The strategy has been developed by Pain Australia, after consultation with others involved in pain management, after the federal government committed funding and support for a plan in May 2018.
It will be presented to the states and territories for endorsement at the Council of Australian Governments' meeting in the coming weeks.
The plan comes as one-in-five Australians live with chronic pain, including some adolescents and children.
17 June 2019
Muscle cramps facts
- A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax.
- Muscle cramps can occur in any muscle; cramps of the leg muscles and feet are particularly common.
- Almost everyone experiences a muscle cramp at some time in their life.
- There are a variety of types and causes of muscle cramps.
- Muscle cramps may occur during exercise, at rest, or at night, depending upon the exact cause.
- Dehydration is a common cause of muscle cramps.
- Numerous medicines can cause muscle cramps.
- Most muscle cramps can be stopped if the muscle can be stretched.
- Muscle cramps can often be prevented by measures such as adequate nutrition and hydration, attention to safety when exercising, and attention to ergonomic factors.
Abbey pain scale
The Abbey Pain Scale is used for people with dementia or who cannot verbalise.
http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0018/212922/Abbey_Pain_Scale_Final.pdf
https://www.apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf
- Keep a pain diary- Sometimes it may be easier to answer caregiver's questions by making a pain diary or book. A pain diary or journal will help you remember exactly what happened each day because it is all written down. This will help you to tell caregivers about your pain and may help them understand what causes it. Write down all the words that come to you to describe your pain. A diary also helps track pain cycles. This will help you be more aware of when pain is bad and how to make it better.
When you see your caregiver, he/she will ask you to answer the following questions.
- Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
- How would you rate the pain on a scale of 0 to 10? (0 is no pain, and 10 is the worst pain you ever had.) Then decide what number you want your pain goal to be.
- How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling? There are no right words for pain, so use any words you know to describe how your pain feels to you.
- When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
- How often does the pain bother you and how long does it last?
- Does the pain affect your daily life? Can you still work or do your favorite activities in spite of the pain?
- Does the pain wake you from sleep?
- Do certain things or activities cause the pain to start or get worse like coughing or touching the area?
- Does the pain come before, during, or after meals?
- Does anything decrease the pain like changing positions, resting, medicines, or changing what you eat?
Some health care professionals erroneously believe that the elderly are less sensitive to pain, or give weak doses of pain medications for fear that older patients will not tolerate opioids. They may equate pain management with addiction, or various other avenues of fear authority based.
Be aware: Science News from research organizations
Can over-the-counter pain meds influence thoughts and emotions?
Date: February 6, 2018
Source: SAGE
Summary: Over-the-counter pain medicine such as Ibuprofen and acetaminophen may influence how people process information, experience hurt feelings, and react to emotionally evocative images, according to recent studies.
https://www.sciencedaily.com/releases/2018/02/180206090700.htm
Pain Australia: www.painaustralia.org.au
Australian Pain Management Association www. painmanagement.org.au
NPS MedicineWISE: www.nps.org.au/conditions/nervoussystem-problems/pain/for-individuals/what-is-pain
Chronic Pain Australia: www.chronicpainaustralia.org.au
PRESCRIPTION FOR CODEINE REQUIRED IN 2018
Since the 1st of February 2018, all medicines containing codeine will no longer be available from pharmacies without a prescription. The reasoning behind this decision has been stated as the potential risk of codeine tolerance, dependence, poisoning and even death (in high doses).
Key points
- Extensive consultation and review of current data has concluded that the risks associated with low-dose codeine medicines outweigh their therapeutic benefit.
- From 1 February 2018, low-dose codeine will no longer be available over the counter in Australia – GPs, pharmacists and pain specialists will be at the forefront of managing this transition.
- This decision gives health professionals and patients opportunities to discuss alternative pain management options and explore more effective and safer approaches to pain.
- This decision will also bring to light patients with dependency issues requiring additional care and specialised management.
http://www.health.nsw.gov.au/PainManagement/Documents/appendix-1-national-pain-strateg.pdf
One in five Australians, including children and adolescents, will suffer chronic pain in their lifetime and up to 80 per cent of people living with chronic pain are missing out on treatment that could improve their health and quality of life.
The High Price of Pain report, conducted by Access Economics in collaboration with the MBF Foundation and the University of Sydney Pain Management Research Institute, estimated that chronic pain costs the Australian economy $34 billion per annum and is the nation’s third most costly health problem.
Yet a person with chronic pain — that is, constant daily pain for a period of three months or more in the past six months —faces the following:
• their condition is not officially recognised as a disease or a public health issue
• their family, friends, employers, schools and health professionals will often not believe they are in pain
• many health professionals will have received little or no training in how to treat their condition
• they may have to wait more than a year for an appointment at a service that can help them
• they have little access to community-based support
• their productivity at work may be lowered, which frequently leads to unemployment and impoverishment
• they are personally likely to carry more than half the total economic cost.
People with chronic pain are at substantially increased risk of:
- depression,
- anxiety,
- physical deconditioning,
- poor self-esteem,
- social isolation and
- relationship breakdown.
- Children and adolescents with chronic pain are absent from school more often than their peers, and participate in fewer sporting activities. They may never reach their full academic or vocational potential. Their reduced physical function and mobility can lead to loss of independence, and they may not be diagnosed and treated for social anxieties that may have contributed to, or result from, their condition.
In the psychological and environmental (social) domains, there is ample evidence that there are important changes in people with chronic pain that play a significant, and sometimes dominant, role in the ongoing experience of chronic pain and in the impact that the pain has on the individual’s quality of life.
For example, mood changes such as anxiety and depression share neurotransmitters with chronic pain.
Fear-avoidance behaviour is frequently associated with chronic pain and leads to a downward spiral of reduced activity, deconditioning, postural changes, and loss of muscle support of various joints and also the spine.
Pain Australia has great professional resources to help very Australian access the best possible treatment without delay, to reduce long-term disability, improve work retention rates, and help people and their families live better lives: www.painaustralia.org.au
Australian Pain Management Association works with health clinicians, researchers, government and the community to deliver evidence-based pain management services: www.painmanagement.org.au
Chronic Pain Australia can help you improve your knowledge and understanding about chronic pain across Australia www.chronicpainaustralia.org.au
The Australian Society for Geriatric Medicine [Position Statement No. 10 - Point 1] states:
Wednesday, 20 February 2008 23:46
"Australia is at the forefront of international research and practice in virtually every field of health care, except residential aged care.
We currently fail to collect even basic data about the health status of people in residential care; or about our existing health care practices and their outcomes, in this setting. We turn our backs on international residential care comparative studies".
Residential Aged Care from the Geriatricians Perspective
The above statement is sad, but true. I am fortunate that I am still at an age when I can detail my pain episode experiences, and find there are remedies available. Many of our elders are not as fortunate.
Growing old gracefully is one thing. Doing it pain free is far more important!
Too Many Seniors Suffer Needlessly from Untreated Pain.
Senior citizens are undertreated for pain far more often than younger patients. According to various studies conducted (America), 40% to 80% of elderly nursing home residents suffer needlessly due to inadequate pain treatment.
Pain in elderly patients is not always assessed properly, and may be under-reported. Too frequently elderly patients do not report their pain because they fear retaliation, the possibility of addiction, or loss of respect. They may be stoical or believe that pain is a natural part of ageing.
Formal pain assessment should be routine. Such formal assessment can be carried out with a very simple assessment tool that evaluates pain intensity, quality, location, and duration. However, formal pain assessments may not be sufficient for those with speech, hearing or cognitive deficits or who fear reporting pain. Close observations of behaviour may reveal expressions, movements, and activities indicative of pain.
According to the American Geriatrics Society (AGS) Panel on Chronic Pain in Older Persons (1998), chronic pain in the long-term care setting is generally under-recognised and under-treated.
Treatment of chronic non-cancer pain among those with non-terminal illness especially, has been neglected. Teno et al., in their study “The Prevalence and Treatment of Pain in US Nursing Homes,” found that pain is a common condition in nursing homes, and that nearly one sixth of all nursing home residents were reported to be in daily pain. For residents with cancer, slightly more than one in five was in daily pain.
More problematic was the fact that:
- pain symptoms were noted on the last pain assessment in one of five individuals who died and
- the final pain assessment of these residents was so long (on average 47 days) before death.
There are several specific reasons rooted in the nature of pain and societal attitudes toward it. Pain is subjective and lacks objective biological markers.
Pain - Common Misconceptions
Some of the common misconceptions about chronic pain in elderly people include:
- It is a sign of personal weakness to acknowledge chronic pain.
- Chronic pain is a punishment for past actions.
- Chronic pain means death is near.
- Chronic pain always indicates the presence of a serious disease.
- Acknowledging pain will lead to a loss of independence.
- The elderly, especially the cognitively impaired, have a higher tolerance for pain.
- The elderly and the cognitively impaired cannot accurately self-report pain.
- Residents in long-term care say they are in pain in order to get attention.
- Elderly residents are likely to become addicted to pain medication.
The most accurate and reliable evidence of the existence of pain and its intensity is the residents’ self-report. Elderly people often describe discomfort, hurting, or aching, rather than use the specific word “pain.”
Pain Management and Monitoring:
Sometimes the elderly are not able to speak about their pain. See here for "What if I cannot talk?". This may be further complicated with illness or injuries like dementia, brain damage, or a stroke. This makes it very hard for caregivers and family to recognise the existence of pain.
- Monitoring the use of analgesics and other pain medication is time consuming.
- In nursing homes, pain management may be limited if staffing is inadequate.
- Also, some nursing homes are unwilling to stock restricted drugs that may be useful in the treatment of pain.
- Diagnosing a senior’s pain may be difficult. Although grimacing, restlessness, moaning, and agitation may often indicate pain, they are not definitive signs of pain.
The under-treatment of pain has been considered neglect, negligence, or even elder abuse. If you are concerned about the under-treatment of your elderly relative’s pain, talk to his or her physician and nursing team. Also keep records of the problem.
Prevalence of Pain in the Elderly:
Pain is reported to be twice as prevalent in the elderly as in younger individuals (Crook et al., 1984). In community-dwelling elders, the prevalence of pain ranges from 25-50% (Mobily et al., 1994). In the long-term care setting, prevalence can be as high as 85%.
(Stein et al., 1996).
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http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/159846/Pain_MOC.pdf
There are few human experiences that are as compelling as pain, yet it remains poorly managed by professionals in a range of health care settings. While there is a large body of research into the mechanisms of pain, pain management and improved techniques for pain control, many people continue to suffer with unrelieved pain. The high prevalence of pain, and its impact, makes pain a public health issue (Fox, Parminder & Jadad 1999; Blyth et al. 2004; NPS 2010).
Indeed, it seems incongruous that while scientific research has uncovered many of the biochemical, neurobiological and psychosocial processes of pain, along with the development of sophisticated treatments for its control, many people, even in countries such as Australia, continue to live with chronic, unrelieved pain. There is no cure for chronic pain, so options at present are directed towards minimizing its impact. Nationally and internationally, the problem of unrelieved pain is set to increase as the population ages with the magnitude of the problem amongst those with cognitive impairment and communication difficulties escalating.
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One in every four Australians is experiencing low back pain right now. Many people believe that if they are in pain they need a scan (an X-ray, CT or CAT scan or MRI scan), but actually this isn’t true. Read on to learn why scans are often unnecessary, and how staying active can help you recover faster.
https://www.nps.org.au/medical-info/consumer-info/10-things-you-need-to-know-about-low-back-pain
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Professor Ken Hillman said on average a dying person in Australia will be admitted to hospital eight times in the last year of life and make two visits to the emergency department, while 60 to 70 per cent will die in hospital.
With one-third of all medical interventions in the last year of life deemed futile, anaesthetists and surgeons were on Tuesday asked to reflect on the role they play in end-of-life care.
Hillman said frailty should be one of the most important guides to determining whether surgical intervention is worthwhile. “Age-related frailty is not curable,” he said.
14 May 2020