29 JULY 2021

This week marks National Pain Week and the 10th anniversary of the founding of Painaustralia.

These significant markers encourage us to reflect on the journey to have chronic pain recognised as a major and often debilitating health condition.  Many people now understand that pain is a condition that affects over 3.4 million Australians and costs the economy over $73 billion per annum, increasing to more than $140 billion when the impact of quality of life is taken into account[1].

Our 10th anniversary also provides an opportunity to acknowledge the work of Painaustralia’s founder and pain medicine pioneer, Dr Michael Cousins AO. The biography, Breaking through the Pain Barrier: The Extraordinary Life of Dr Michael J. Cousins, written by former patient Gabriella Kelly-Davies, documents Dr Cousins’ tireless work improving the treatment of pain. Painaustralia hosted an online launch of the book on Sunday 25 July 2021 as part of our contribution to National Pain Week.

As well as founding Painaustralia and designing Australia’s first National Pain Strategy (NPS), Dr Cousins genuinely changed the way that Australia responds to pain. Through his advocacy for chronic pain to be understood as a condition in its own right, he made the condition visible at a time when the medical profession was not yet ready to accept pain medicine as a legitimate field of practice.

The journey to place pain on the national agenda in Australia has not been easy or quick.  It has required building a large and influential coalition of support and shared commitment to a health condition that continues to remain largely invisible on the public health agenda.

Some of the key steps along the way have included:

• the formation of the Australian chapter of the International Association for the Study of Pain (IASP), the Australian Pain Society in 1984;
• the establishment of the Faculty of Pain Medicine and a separate Chapter of Palliative Medicine as medical specialities in 2005; and
• Australia’s National Pain Summit in 2011, which brought together over 200 representatives including health professionals, consumers, industry, funders and policy makers and agreed to adopt the (world’s first) National Pain Strategy (NPS). 

Painaustralia was established to implement the NPS in 2011.

The National Pain Summit in 2011 generated considerable enthusiasm and momentum, with the states and territories also coming on board with their own plans and funding. NSW adopted the most ambitious plan thanks to the then health minister, the Hon Jillian Skinner.  Mrs Skinner championed the cause, attracting significant funding which has made a real difference to the lives of those living with pain conditions. This then drove models of care that have enabled pain treatments to be made accessible and relatively affordable in NSW. 

Following the development of the NPS, Painaustralia worked closely with people with lived experience of chronic pain to provide evidence-based policy advice to government and stakeholder groups to enable them to build their agendas for pain management.

The impact of opioid medicines on the Australian community, together with rising health costs related to pain management, are factors that have assisted to keep the issue on the national agenda, while leading to the impetus for increased opioid regulation. 

Perhaps the most significant turning point came in 2018, when the Australian Government provided funding to Painaustralia to develop the current blueprint for pain management: the National Strategic Action Plan for Pain Management (NAP). The NAP brought together a wide range of representatives from consumer, health professional, industry and funding organisations as well as policy makers.

In addition to an extensive consultation process, the development of the NAP was informed by the evidence set out in the Cost of Pain Report 2019, that Painaustralia commissioned Deloitte Access Economics to undertake.

Since its launch in 2019, the NAP has provided a platform for continuing advocacy – especially in supporting evidence-based multi-disciplinary care.  The Federal Government has, to date, funded the following components of the NAP:

• National Pain Services Directory – enhancing and promoting a directory of pain specialist services;
• National Communication and Education project – funding to develop Painaustralia’s website into an information hub/one stop shop and app for evidence-based information about pain management;
• Take Home Naloxone program;
• Consumer awareness campaigns – on opioids and naloxone;
• Health practitioner education – funding for a national strategy and practitioner education;
• Rural Health Outreach Program – expansion to include pain in rural services.

Painaustralia is continuing to work closely with States and Territories to engage them in supporting the NAP. This is particularly important following the regulatory changes to limit access to opioid pain medication, which has to date been the mainstay of affordable pain treatment in Australia. 

It has been a rewarding journey over the past 10 years, although we have encountered a few challenges along the way particularly in relation to keeping pain management on the national policy agenda.

Some of the important lessons that we have learned include the need to have:

• broad consumer-based advocacy (including our consumer advisory group, diverse consumer network as well as high-profile supporters including Tara Moss, Sir Angus Houston, Peter Rudland, Sophie Scott and Liesl Tesch MP to champion our cause);
• a level of public concern (opioids have led to more public attention) - driven by effective campaigning which has helped create an environment where politicians feel compelled to take action;
• a well thought through political strategy that elicits support from the government through research and evidence as well as acknowledges positive actions such as support for the development of the NAP. We have also worked to establish the Parliamentary Friends of Pain Management group to harness support of politicians on all sides of politics;
• a compelling research/evidence-based case to inform advocacy with politicians and the Department which we addressed through commissioning the Cost of Pain report;
• in more recent years we have also been fortunate in having a supportive Health Minister.

While we can be pleased with the progress we have made, there is still much work to be done as we continue to manage the enduring realities of achieving significant national policy change.

These include acknowledging:

• changing national policy is never a straightforward journey;
• the complexity of policy change and the need for multiple strategies;
• persistence, opportunity, patience and consistency do pay off in the long run;
• substantial health policy change takes at least a decade to achieve in Australia. 

We will also need to ensure that the work we have done to focus governments on developing a national approach to pain management in Australia continues as the Covid crisis eases.

Once again, I would like to acknowledge Dr Cousins for his passion in starting us on the journey and for his life’s work in helping people with chronic pain, developing more effective treatments and in changing the health and policy agendas.

Carol Bennett, CEO