Calls for chronic pain to be seen, counted and treated

The Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists (ANZCA) has welcomed the release of the National Pain Report, Pain Lives Here, saying its findings spotlights the urgent need for chronic pain to be recognised as a national health priority.

Released during National Pain Week (26–31 July), the report from Chronic Pain Australia draws on responses from more than 6,000 Australians living with chronic pain. It reveals widespread delays in diagnosis, barriers to accessing appropriate care, financial hardship and the profound impact of persistent pain on mental health, employment and overall quality of life.

Chronic Pain Australia Chair Nicolette Ellis said the findings expose the scale of a condition that affects millions but remains largely hidden.

“Pain lives in our homes, our workplaces, our schools and our communities. Yet despite affecting millions of Australians, it remains largely invisible within the systems responsible for measuring, planning and responding to it,” Ellis said.

“That is Australia’s National Pain Gap,” she added. “When pain isn’t measured, it isn’t seen. When it isn’t seen, it isn’t prioritised. The consequence is that people spend years searching for answers, leave the workforce, experience financial hardship and face declining mental health while the system struggles to recognise the full scale of the problem.”

One in five Australians live with chronic pain, making it one of the nation’s leading causes of disability. Yet despite its prevalence, chronic pain continues to receive only a fraction of the recognition, funding and policy attention afforded to other major chronic health conditions. Without reform, the annual cost of chronic pain is projected to rise from $139.3 billion in 2018 to $215.6 billion by 2050.

Faculty of Pain Medicine Dean Professor Michael Veltman said the report’s identification of the “national pain gap” reinforces the need for greater investment in pain education and multidisciplinary, evidence-based care.

“The survey confirms what our fellows already see every day in clinical practice. Chronic pain is a major public health issue affecting one in five Australians and remains one of the leading causes of disability, yet too many people continue to experience barriers to appropriate assessment and treatment,” explained Professor Veltman. “Persistent pain is complex. Improving outcomes begins with ensuring health practitioners have the knowledge and skills to recognise, assess and manage pain using contemporary, evidence-based approaches.”

Neuromodulation is a treatment option that provides pain relief for patients suffering from failed back surgery syndrome, complex regional pain syndrome and intractable cancer pain. Although it is not a treatment used in isolation, it facilitates an effective option particularly where conventional treatment methods fail to provide effective pain relief.

Spinal cord stimulators (SCS) from Abbott, Boston Scientific and Nevro Medical are predominantly used in the private healthcare system, with nearly 90% of insertions performed in private hospitals. Under mounting scrutiny, the Neuromodulation Society of Australia and New Zealand (NSANZ) has tightened clinical guardrails, publishing guidelines that seek to optimise patient outcomes and minimise complications of SCS in chronic pain management.

“Among neuromodulation modalities, spinal cord stimulation (SCS) has shown promise in treating neuropathic pain and other challenging chronic pain conditions. However, variability in patient selection, procedural approaches, and post-implantation care has led to inconsistent outcomes,” said the authors.

Within the Chronic Pain Australia’s report, one of the most concerning findings was the disproportionate burden carried by Australians whose chronic pain began early in life. More than one in three respondents (38%) developed chronic pain before the age of 25 and consistently experienced poorer outcomes across almost every area of life.

Compared with those whose pain began later, they were almost twice as likely to wait more than three years for a diagnosis (57% compared with 29%), more likely to experience mental health issues (85%), financial strain (73%), workforce disruption and thoughts of taking their own life (44%). The findings suggest delays in recognising and treating chronic pain early can shape an individual’s entire life trajectory.

The report also highlights that the consequences of chronic pain extend well beyond the healthcare system, affecting education, employment, families and communities.

“This report shows pain doesn’t stay inside hospitals or specialist clinics. It follows people into classrooms, workplaces, family life and retirement,” explained Ellis. “The National Pain Report provides some of the strongest evidence available of what Australians living with chronic pain experience every day. It should be a catalyst for recognising chronic pain as a national health priority.”

The findings also arrive as Australia faces a growing gap in its ability to monitor chronic pain nationally. Following the closure of the electronic Persistent Pain Outcomes Collaboration (ePPOC), the National Pain Report is now the only source of national data on the lived experience of chronic pain in Australia.

Professor Veltman said rebuilding national pain data capability should be a priority.

“Alongside surveys such as the National Pain Report, Australia needs robust outcomes data and clinical registries to better understand what treatments work, improve the quality of care and measure outcomes for people living with pain, including those receiving pain device therapies,” said Professor Veltman. “Better education and dedication to clinical data registries leads to better clinical decision-making, more consistent care and ultimately better outcomes for people living with pain.”

The Faculty of Pain Medicine has recently launched the Australian Standards for Health Practitioner Pain Management Education, the first nationally consistent framework designed to guide pain management education across all health professions and every stage of clinical training.

“The new standards provide a practical framework to strengthen pain education across disciplines,” said Professor Veltman. “They recognise that every health practitioner, not only pain specialists, needs the skills to assess and manage pain effectively, communicate compassionately and work collaboratively with patients and multidisciplinary teams.”

Chronic Pain Australia is using National Pain Week to call on governments to recognise chronic pain within Australia’s national health data as the first step towards closing the National Pain Gap. Better data means better planning, better investment, and a health system that no longer overlooks millions of Australians living with pain every day.

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