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Last week Dr Claire Ashton-James, a social psychologist and senior lecturer at the University of Sydney's Pain Management Research Institute and Professor Paul Glare, a pain and palliative care specialist and director of the Pain Management Research Institute (and Painaustralia Board Director), penned an opinion piece for the Sydney Morning Herald. If you haven’t read it already, I would highly recommend this excellent and insightful article. It does a great job of highlighting not just the medical and regulatory changes in pain management, but most importantly is empathetic with many consumer views. 

Painaustralia understands the need for regulation and oversight, and is working closely with the Federal Government as a member of the TGA Opioid Regulatory Advisory Group to strengthen clinical guidelines and regulations around opioids to address significant harm.  Research has now demonstrated that some of these changes, such as the up-scheduling of codeine, have resulted in a drop in poisonings by an astounding 79%.  That’s not to be dismissed.  This week, another study published in the MJA finds that the number of presentations involving codeine products in one toxicology unit was 85 per cent lower after rescheduling.

Yet it is also important to remember that aside from these statistics, there are people who now find themselves unable to access pain management in a way that enables functional quality of life.  There are always exceptions to the rule - acknowledging that opioid medication is generally not recommended for chronic pain conditions. 

Everyday Painaustralia hears from consumers sharing their experience of living with chronic pain. Many share the examples of support and the success they have had in dealing with their condition.  A lot more share the abject fear that they live in, afraid that one day the medication that they consider their lifeline, will be taken away. They share the daily burden of stigma and discrimination for trying to seek help to ease the unrelenting pain of conditions that a biomedical model has limited answers to – conditions such as Fibromyalgia, Complex Regional Pain Syndrome and Trigeminal Neuralgia to name a few.

We know that the toll pain takes on an individual is far from physical. Nearly half the people living with chronic pain also live with anxiety and depression. Research has explored the association between chronic pain and psychological pain, particularly in the context of depression, and the role of suicide as an attempt to escape from what is perceived as unbearable suffering.  Results suggest that chronic pain may facilitate the development of a key risk factor for suicide: fearlessness about death. 

Yet it is perhaps inevitable that we are now rapidly progressing down a path that will see further restrictions on pain medications for chronic non cancer pain.  We are at a critical juncture where we must ensure that we don’t become intent on regulation as the only solution to growing opioid problems and that we do not balance the equation with access to medications where it is indicated as well as other interdisciplinary best practice interventions that can help people to live as well as they can with chronic pain. 

We hope Australia’s health ministers are listening as they consider endorsing a national approach outlined in the National Strategic Action Plan for Pain Management in the coming weeks.

This Friday, Painaustralia will join our members - the Pain Management Research Institute and other partners including the Kolling Institute, the University of Sydney and NSW Health for a symposium on opioid deprescribing for chronic pain.  This will be an opportunity to explore the how, when and why of opioid tapering for chronic pain and solutions to ensuring that in an attempt to curtail harm, we don’t make it harder for some people to achieve a functional quality of life.

Carol Bennett, CEO

video recordings of the symposium on opioid deprescribing for chronic
https://www.armchairmedical.tv/category/Opioid+Tapering+for+Chronic+Pain/146377702