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32 PAIN MANAGEMENT FROM PAGE 31 • The total financial cost of chronic pain in Australia in 2018 was estimated to be $73.2 billion, comprising $12.2 billion in health system costs, $48.3 billion in productivity losses, and $12.7 billion in other financial costs, such as informal care, aids and modifications, and deadweight losses. “The biopsychosocial conditions around pain are incredibly complex, making biomedical interventions alone unlikely to be useful, and it often requires a long time to diagnose pain, then treatments can be difficult to target and get right, to help patients to function,” Ms Bennett said. Also, she points out, the longer pain remains untreated, the greater the risk of the body becoming sensitised to pain, and the pain becoming chronic, so timely and effective treatment of acute pain is essential to prevent transition to chronic pain. The statistics show that referrals to pain specialists occur in less than 15 per cent of GP consultations where pain is managed, and that is significant, Ms Bennett underscores. These facts have resulted in “quite an issue” around the need to support people experiencing acute and chronic pain. “However, often patients find supports on the ground aren’t good enough to enable them to manage their pain, resulting in many tests that are unnecessary, which at times extends to surgery,” Ms Bennett said. “They then turn to opioids, which are probably not that useful and, as we well know, can cause other problems. Yet despite all the negatives, people still turn to them, instead of taking a more proactive approach.” Such an approach, she says, focuses on active pain management, exercise, a nutritious diet and mental health support, or other support as required from health professionals. “It’s generally well known now that medication, in fact, plays a limited role in managing acute and certainly chronic pain,” Ms Bennett said. Pain management during the COVID-19 crisis During COVID-19, continued pain management care is facilitated by expanded, Medicare-subsidised telehealth services for all Australians and the extra incentives provided to GPs and other health professionals to maintain support for access to essential primary health services. As to treating the pain of COVID-19, many health experts have warned that taking anti-inflammatory drugs such as ibuprofen could be a factor in aggravating the virus infection, advising that paracetamol should be taken instead. But Ms Bennett highlights that this advice has been recently overturned. “Ibuprofen was previously reported to heighten the risk of contracting the virus and developing a severe form of illness,” she said. “These previous reports were based on animal studies rather than direct reports from the clinical outcomes within the pandemic. Stopping its use for pain isn’t recommended and caution remains about its use to control fever, although there’s little basis for this in current evidence.” Painaustralia has created a COVID-19 hub on its website to assist the many consumers searching for clear information about how they can best manage their chronic pain. The organisation has also developed the National Strategic Action Plan for Pain Management, funded by the federal government. The plan comprises about 50 fundamental actions and eight goals for addressing the complexities of pain management in Australia (click here to access the plan). Pharmacists major players on the ground Ms Bennett says pharmacists should never underestimate how much they can help manage the complexities of pain management, given their: • Ability to correctly approach patients in pain. • Good handle on medication management. • Knowledge of best practice approaches, including being part of a multidisciplinary primary healthcare team and local healthcare services. • Ability to navigate available drugs, including negative drug interactions and other tools that work, such as heat packs. • Role in medication reviews. Such qualities were referenced in the presentation she prepared for TerryWhite Chemmart recently, where she recounted how a Painaustralia consumer advisory group member, living on compensation with a neck injury, recalled how a pharmacist became the most critical person in assisting her to identify and overcome her opioid dependence. “I work closely with yoga and meditation schools within the community and am happy to refer people when I feel it would help.” RETAIL PHARMACY ASSISTANTS • JUN 2020