The MBS Review is set to consider items specific to pain management as GPs and patients complain that current arrangements are “hopelessly inadequate” to cover the costs of treating complex chronic pain effectively.
A spokeswoman for the Federal Health Department confirmed a clinical committee devoted to pain management would be established in the next few months to review items for GP and specialist consultations, specific pain management procedures, multidisciplinary care plans, allied health services, and items for mental health services.
Chair of the MBS Review Taskforce, Professor Bruce Robinson, will address Painaustralia’s AGM on Monday, where he is expected to discuss trials of the Health Care Home recently announced by the Federal Government and other areas relevant to pain management under review by the taskforce.
Chronic pain has been recognised as a chronic condition in its own right by the Federal Health Department for several years, allowing a multidimensional treatment approach to care which can include psychotherapy and other allied health support such as physiotherapy, nutrition and physical activity advice, hydrotherapy, acupuncture and massage.
However, GPs and Painaustralia say under current MBS arrangements, chronic pain hasn’t kept up resulting in inadequate funding for pain treatment, leaving patients with limited access to these evidence-based therapies for chronic pain.
Painaustralia is lobbying the MBS Review to introduce a Medicare item number for a Chronic Pain Care Plan, which would combine the existing Chronic Disease Management Plan (which allows Medicare funding for five allied health consultations) and the Mental Healthcare Plan (which allows six plus four sessions with a clinical psychologist).
“What we have managed to do is have chronic pain recognised as distinct from acute pain as a condition in its own right, so patients are therefore eligible for a chronic disease care plan which allows for five allied health visits.
“But this is hopelessly inadequate to treat people with chronic pain whose conditions are very complex and usually need some psychological support in addition other therapies,” said Painaustralia CEO, Lesley Brydon.
Sydney GP Dr Hester Wilson, who is also an addiction medicine specialist with training in pain management, said: “The issue we have as GPs is that it can be really difficult for us to access non-pharmacological treatments for our patients.”
“Under Medicare I can’t do a mental health care plan and refer to a psychologist for chronic pain. The patient has to have depression or anxiety – but I want to refer my patients for psychological support before they get a mental health issue,” she said.
“GPs want to do what works, and we know psychological therapies do work in getting people actively engaged in their pain.”
Chronic non-cancer pain affects one in five patients attending general practice in Australia1. Recent studies have shown that early intervention including psychological assessment and support can prevent the transition of acute or sub-acute pain to chronic pain2. Yet despite Australian guidelines recommending that pharmacotherapy should be seen as an adjunct only in the treatment of chronic pain3, more than half of patients with chronic pain are treated in primary care with drugs alone4.
The Australian Commission on Safety and Quality in Health Care’s Australian Atlas of Healthcare Variation5, launched in November, revealed high levels of opioid prescription for patients with chronic non-cancer pain, particularly in areas of socioeconomic disadvantage.
It found that of the nearly 14 million prescriptions for opioids dispensed through the PBS in 2013-14, the number of prescriptions dispensed was 10 times higher in the area with the highest rate compared to the area with the lowest rate. “There is no apparent explanation for this, although the availability of other options for treatment of non-cancer pain may be a factor,” the report said.
1 Henderson JV, et al. Pain Med 2013;14:1346–61.
2 Murphy JL, et al. Clin J Pain 2013;29:109–17.
3 eTherapeutic Guidelines. Analgesic: chronic pain. 2012.
4 SAND abstract No. 112 from the BEACH program 2007–08
5 Australian Atlas of Healthcare Variation, Australian Commission on Safety and Quality in Health Care, November 2015
This content was independently produced by Cirrus Media with a sponsorship from Pfizer Australia.