By Suzanne Harrison
It costs the Australian economy billions of dollars every year, but what is the true cost of chronic pain for the millions of people living with it and are health practitioners equipped to manage it?
Mandy has been living with chronic pain for about a decade and takes around six different medications every night, as well as requiring regular IV drips.
The 59-year-old Perth-based mother of five, suffers from debilitating rheumatoid arthritis and migraines. The former keen netballer and golfer does not want to take the prescribed pain medication, but without it she could not function.
It all started in her 40s with pain in her feet and ankles, then she had trouble walking. After an initial lupus diagnosis Mandy was prescribed steroids but, two years on, sought further advice on whether to continue. Then she was told the pain was caused was fibromyalgia, but was later tested for and diagnosed with rheumatoid arthritis.
“I was annoyed by those initial wrong diagnoses. How could two of them physicians get it wrong?
“Before this, I’d not had any pain like that,” she says. “Now I can’t even play golf, because I can’t hold the club.”
To counteract that, Mandy has been motivated to keep moving with regular gym sessions, but she really misses playing golf.
“No one understands it until they have experienced it themselves,” she adds.
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Mandy’s story is far from unusual in Australia and around the world. According to the Australian Institute of Health and Welfare (AIHW), chronic pain is a condition characterised by persistent pain experienced on most days of the week, and affects one in five Australians aged 45 and over.
Curtin University has estimated chronic pain costs the Australian economy $139 billion every year.
AIWH says chronic pain can result from injury, surgery, musculoskeletal conditions such as arthritis, or other medical conditions like cancer, endometriosis or migraines. In some cases, there may be no apparent physical cause.
Analysis in an AIHW report from 2020 shows that compared with people without pain, people with chronic pain are more likely to:
- be female and older
- have long-term conditions
- stay longer in hospital
- report limitations to daily activities
It is considered chronic if the pain lasts beyond normal healing time after injury or illness – generally three to six months – and the pain experienced can be anything from mild to severe.
The defining characteristic of chronic pain is that it is ongoing and experienced on most days of the week.
This is true for Mandy and millions of other Australians. According to the AIHW analysis, GPs are seeing more people with chronic pain, with patient interactions increasing by 67% over 10 years.
Thankfully, in the years since a 2010 Federal Government pain strategy meeting with specialists including Perth-based Dr Roger Goucke – an Associate Professor at UWA and a former head of pain management at Sir Charles Gairdner Hospital – a lot has been done to move towards standardised treatment and physician and specialist education.
“Since then, a whole lot of positive things have happened, but it is slow,” says Dr Goucke.
“The National Strategic Action Plan for Pain Management came out after a lot of lobbying and, as part of that, the question was asked ‘how do we educate people?’ as it’s well known in med schools that pain management is not well taught.”
Considering that about 20% of the world’s population lives with chronic pain, this had to change.
The original Action Plan was spearheaded by Painaustralia (PA), the national peak body working to improve the quality of life of people living with pain.
In a 2021 report, The Cost of Pain in Australia, PA and the Department of Health found that more than 68% of people living with chronic pain were of working age.
Without action it found the prevalence of chronic pain will increase to 5.23 million Australians (16.9%) by 2050.
By 2032, it is projected that the number of cases of arthritis and other musculoskeletal conditions will increase by 43% to 8.7 million.
Osteoarthritis is projected to affect three million people, up from 1.9 million in the same timeframe, back problems are predicted to affect 3.8 million people, up from 2.9 million, and osteoporosis cases are set to increase to 1.2 million people from 0.8 million.
“Yet many people living with pain cannot get access to best practice pain management, often due to cost, location or low awareness of treatment options, and medication is playing an increasing role,” the PA report states.
To implement the Action Plan, PA consulted widely with consumers, clinicians, allied health practitioners, key health groups, researchers and the medical community to understand what people think the key priorities should be.
As a result, Australia was the first country to have a National Strategic Action Plan for Pain Management.Since then, all Australian states have adopted recommendations.
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The Action Plan, PA says, has been a catalyst for major change in the way pain – especially chronic pain – is understood and managed in Australia and the provision of pain services.
Highlights include:
- Statewide pain plans are in place in Western Australia, Queensland, New South Wales, and South Australia while Tasmania and the Australian Capital Territory are advanced in their planning with a focus on developing community-based services
- A total of 14 new regional pain clinics have been established across the eastern states
- Dedicated paediatric pain clinics have been established at Perth Children’s Hospital in Perth and Lady Cilento Children’s Hospital in Brisbane, and regional paediatric service capacity has been increased at John Hunter Children’s Hospital in Newcastle
- A range of new chronic pain education and training opportunities have been developed for health professionals
- More education for people living with pain, including award-winning online portals PainHEALTH and painbytes.
Meanwhile – through its Faculty of Pain Management (FPM) – the Australian and New Zealand College of Anaesthetists (ANZCA) is leading a project to develop Australian standards for health practitioner pain management education.
ANZCA says the overarching aim of the National Strategy for Health Practitioner Pain Management Education is that health practitioners receive high quality, evidence-based, contextually relevant and timely education throughout their career to support the delivery of best-practice care.
“The development of a set of standards governing health practitioner pain management education will assist in ensuring the consistency, relevance, appropriateness and overall quality of the education provided,” a spokesperson says.
“A set of well-developed and accepted national standards for health practitioner pain management education will aim to inform policy, education, and practice to improve the care of Australians living with pain.”
It is intended that a nationally consistent set of standards for health practitioner pain management education be developed that will:
- Be relevant across multiple health practitioner disciplines and levels of education
- Be underpinned by the values and principles of the National Strategy for Health Practitioner Pain Management Education
- Set the minimum level of quality
- Provide guidance in the development and delivery of pain management education
- Be inclusive of the needs of priority populations.
The final standards are set to go to government in October 2025.
As part of developing the standards, one of five in-person and three online, national stakeholder consultation workshops was held in Perth in August last year.
Twenty-two people took part, with attendees including pain physicians, academics, allied health professionals, people with lived experience of pain, peak body representatives, nursing staff, and health professional educators.
Dr Gouke, who attended, said the workshop was a way for stakeholders to collaborate and consult.
“There was amazing consensus, more about the communication than the content,” he says.
“This involved how do we have good relationships with people and make sure the doctor is on the same page? How can we put the patient at the centre, and if we can’t find a cause, how can we help?”
ANZCA says a governance advisory group, consisting of a range of relevant stakeholders, was established in the early stages of the project to provide advice and guidance to the FPM project team.
RACGP Pain Management Chair Dr Adele Stewart told Medical Forum that GPs are in great need of improved knowledge and skills in pain management.
“There is certainly quite a lot in the literature confirming that many GPs struggle in managing people’s pain,” says Dr Stewart.
“For example, an article in ‘Australian Family Physician on GP Pain Management’ states ‘The literature shows that GPs have low satisfaction in treating patients with chronic pain and only 34% of primary care physicians felt comfortable in managing these patients.”
ANZCA’s spokesperson adds: “It would be great if GPs are aware of the National Strategy for Health Practitioner Pain Management Education and take the opportunity to be engaged in any stakeholder consultation activities.”
While this standardised approach to care and education has been a while in the making, pain medicine has been recognised as a separate specialty since 2005 in Australia and 2012 in New Zealand, and the two countries are considered pioneers in the field.
Another step in the right direction is a 2022 national blueprint to help health professionals support the many Australians living with chronic pain, developed here in Perth.
Published in the international pain journal PAIN, the ‘Listen to me, learn from me’ framework was co-developed by a national team of Curtin University-led researchers working in partnership with Australian people living with chronic pain, carers and health professionals.
With funding support from a four-year Commonwealth grant, the framework is a blueprint for the development of Australian interdisciplinary pain training programs.
Lead researcher Professor Helen Slater, from the Curtin School of School of Allied Health, says chronic pain was often debilitating for the Australians living with the condition, and with significant implications for the health system and economy.
“Living with chronic pain means lives are often put on hold. You can’t see pain, but it can derail people’s lives,” Professor Slater says.
“People with chronic pain are not consistently supported with high quality person-centred care in Australia, and it’s a similar situation across the world.”
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Dr Salter’s team has utilised the resulting framework to establish an open training platform.
“This has now been established,” says Dr Slater. “And in mid-2025, that open training platform will be launched to any and all health professionals around Australia.”
In a nutshell, ANZCA and people including Dr Slater have worked to develop a clear way forward for pain management education for health practitioners.
Dr Slater and her team have formed an education program, while ANZCA has developed the upcoming, Australia-wide educational standards for training and pain management for all medical professionals.
For people like Mandy, finding such care, medication and ongoing support is vital. While she would much prefer to be medication free, Mandy says “I would fall to the ground” without them.
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