Guest Article: Opportunities for Primary Health Networks (PHNs) to prevent chronic pain

A project currently being conducted by The Australian Prevention Partnership Centre focuses on Australia’s Primary Health Networks (PHNs) and the secondary prevention and management of chronic pain.

The project is led by University of Sydney researchers, Professor Fiona Blyth, Dr Simone De Morgan and Ms. Pippy Walker. The team recently brought together executive level staff and program leaders from PHNs in a ‘dialogue’ to discuss the options to improve the secondary prevention of chronic pain and to understand what PHNs would be most interested in implementing in their PHNs.

Dr De Morgan said, “We mapped current PHN chronic pain initiatives and found a gap related to the secondary prevention of chronic pain with most initiatives currently being implemented by PHNs related to the management of chronic pain. The aim of bringing PHN representatives together in the dialogue was to improve the awareness among PHNs of the opportunities for early intervention to prevent the progression to chronic pain.”

Professor Blyth said, “Identifying people at risk of developing chronic pain after injury, surgery or with acute back pain is crucial. Many risk factors for poor recovery are modifiable such as depression, pain catastrophising, avoiding movement or activity while in pain, lack of social support and poor job satisfaction.”

PHN representatives who participated in the dialogue valued the opportunity to share ideas with other PHNs and “find out what other 'like' PHNs are doing and what we could replicate or collaborate on.”

Opportunities for PHNs to help prevent chronic pain include consumer and community initiatives, health professional education and training, and health system support initiatives. Dr De Morgan said, “Many initiatives that are currently implemented in PHNs to address the management of chronic pain could also be adapted to help people with acute and subacute pain.”

One of these initiatives is face-to-face multidisciplinary consumer pain programs that incorporate education and physical and psychological strategies. These programs may involve one or several group-based education sessions and may involve individual consultation with primary care providers.

There are different models for implementing community-based consumer pain programs and the project team is planning this year, in partnership with the NSW Agency for Clinical Innovation and Painaustralia, to look at the different ways PHNs are implementing and evaluating these programs. “We hope to develop an information resource for PHNs to help them select the type of consumer pain program model that suits their local context and resources,” said Ms Walker.

Face-to-face multidisciplinary consumer pain programs are currently implemented for people with chronic pain in six PHNs and WAPHA, Western Australia Primary Health Alliance. However, these programs could also be adapted to help people in pain in the first twelve weeks.

Ms Joyce McSwan is part of the Steering Committee for the project and pioneered the Gold Coast PHN Persistent Pain program (Turning Pain into Gain Program). She said, “There is increasing need for early identification and intervention within communities to avoid progression to chronicity.”

PHN representatives at the dialogue expressed an interest in implementing consumer pain programs for people with acute and subacute pain. They also discussed the challenges of implementing consumer pain programs given the lack of reimbursement under Medicare for group sessions and the limited resources of PHNs. PHN representatives suggested that PHNs need to think about all the potential funding streams open to them and to share ideas with each other so as not to ‘re-invent the wheel’.

As a result of the dialogue with PHNs about the secondary prevention of chronic pain, a tender by Eastern Melbourne PHN has opened to procure services "to deliver an integrated solution that activates a responsive provider network to achieve timely recovery from pain in the post-acute and sub-acute phase. The response will provide early identification of individuals at risk of transitioning to a chronic pain state, and harness suitable community-based services." For more information see https://www.eprocure.com.au/emphn/

Declaration

The Chronic Pain Project at the Australian Prevention Partnership Centre is funded by the Medical Research Future Fund Boosting Preventive Health Research Program. Additional funding to support this project has been provided by the Sydney Medical School Foundation, University of Sydney.

Author biography:

Dr Simone De Morgan is a research fellow at the Menzies Centre for Health Policy, University of Sydney and is leading the Chronic Pain Project with Professor Fiona Blyth. The project is part of the Medical Research Future Fund Boosting Preventive Health Research Program initiative conducted by The Australian Prevention Partnership Centre (2018-2020).