Chronic Pain Management

08 Apr 2008 questionsarchive

I seek leave to make a brief explanation before asking the Minister for Mental Health and Substance Abuse questions about the controlled substances legislation.

The Hon. J.M.A. LENSINK: The Liberal Party has received a large number of letters and phone calls from people living with chronic pain who believe they are being treated as drug addicts now that they have to attend Warinilla Clinic for assessment following the retirement of pain management specialist, Dr Ian Buttfield. A number of these constituents state that they feel that, while the staff at Warinilla Clinic may be highly skilled in the management of drug dependence, it is not necessarily the case with pain management, and they feel it is inappropriate. My questions are:

1.What specific training does the staff at Warinilla Clinic have in the management of chronic non-malignant pain?

2.Has the minister met with any of the patients who have been affected by this policy change?

The Hon. G.E. GAGO (Minister for Environment and Conservation, Minister for Mental Health and Substance Abuse, Minister Assisting the Minister for Health) (14:32): I thank the honourable member for her important questions. Chronic non-malignant pain is pain that continues for more than two to three months. It is a very common disorder and, unfortunately, it occurs in about 20 per cent of the population at some time in their lives.

Pain, as we know, is an incredibly complex thing with a range of different components to it. Patients may need to be assessed by a multidisciplinary panel in a pain management unit. A range of treatments may be used for the treatment of chronic non-malignant pain, including non-drug treatments such as physiotherapy, weight control, surgery, and drug treatments such as anti-inflammatory drugs, membrane stabilisers, anti-depressants, non-opioid analgesics and opioid analgesics. The use of opioid drugs, in some cases, is essential for the treatment of severe pain; however, unfortunately, as our evidence suggests, these drugs are also subject to inappropriate medical use leading to abuse, misuse and sometimes diversion to the black market for illegal sale.

We know that the treatment of chronic pain may be complex as chronic non-malignant pain may evolve into chronic pain syndrome which, quite simply, can destroy a person's quality of life. Complex chronic non-malignant pain patients make very heavy demands on a prescriber's limited time. Some can be uncooperative and aggressive when pain is not well controlled. Chronic non-malignant pain patients may resent the controls on drugs and dosages that they are under and they may feel that they are unwarranted.

So, we know that opioids are the most effective drugs to treat severe pain. Problems with opioid analgesics, other than the usual side effects that we know of, are, obviously, that patients can become physically dependent and sometimes psychologically dependent on the drugs.

True opioid addiction occurs in only about 5 per cent of cases, and it is a challenge to identify those patients at risk and either avoid opiate use or impose tighter controls—and that is obviously quite challenging for us at times. As I have outlined, this can be a very difficult group of clients to deal with. The need for a state authority under section 18A of the Controlled Substances Act for treatment of long-term patients helps achieve the following: ensures that one prescriber is involved (or treatment limited to one practice) to prevent uncontrolled prescription, that is, shopping around; reinforces the need for full investigation of the cause of pain and ensures that alternate treatments or surgery is explored; and ensures appropriate referral to other specialist prescribers or clinics for opinions. It also supports the prescriber to limit drugs, dosage form and doses at appropriate levels and to comply with accepted chronic pain treatment principles. There are a number of measures that we put in place to manage what is a very complex problem, one that can cause devastation to people's lives and their families and lead to some very complex and untoward side effects.

I am aware that, for those people who require this ongoing opioid management, there is a range of ways that authorities can authorise certain prescribers. I understand that, when (for whatever reason) there is a change to the authorised prescriber's authority, we ensure that the clients of that prescriber are diverted to alternate ways of receiving and managing their treatment. As I said, it is not a matter of just giving out medications. I am not aware of referral to the Warinilla Clinic of any particular clients, but I am happy to investigate that. I am also happy to find out the qualifications of any staff there who are involved in chronic management treatments or administration of medications and bring those details back to the chamber.