The Difficult Problem: Chronic Pain and the Politics of Care
This approach is presumably intended to reduce the Government’s fiscal risk, and the associated ‘moral hazard’ assumed to arise if governments were to accept subjective reports of pain as a legitimate basis for a claim to relief.
However, could such an essential scepticism of the reality and legitimacy of a person’s pain contribute to the difficult problem, by encouraging stigmatisation of chronic pain sufferers, damaging doctor-patient relationships, compelling unnecessary scans and tests, and incentivising ongoing disability and old-school treatment approaches?
Chronic pain is, by definition, chronically unpleasant and chronically protective. We contend that the politics of chronic pain bear some semblance to chronic pain itself. That is, powerful and complex protective mechanisms for avoiding fiscal risk and maintaining the equilibrium of the body politic have become maladaptive and self-defeating. We discuss biological and sociological reasons why the politics of chronic pain may be contributing to the problem itself.
The burden of pain and Australia’s National Pain Strategy
Everyone knows what pain is but not everyone knows what it is like to have pain day in, day out, week after week, month after month. A surprising number of Australians do however, and it is their pain that stops them from going to work, school, university. It is their pain that wreaks havoc on their mood, their relationships, their engagement in meaningful or productive activity.
One in five Australians, about the same population as Sydney, suffers from chronic pain that reduces their quality of life. Chronic pain cost Australia AUD 34 billion in 2007.
The realisation of the unmet needs of people in chronic pain led to the development in 2010 of Pain Australia – a coming together of some leading pain experts, consumer groups and key stakeholders. Their purpose was to develop a National Pain Strategy – a way out of what was seen by some at the coalface, to be a complete mess and a national disgrace. Fifteen months and a posh gathering in Parliament House’s Great Hall later, the National Pain Strategy was completed and presented to representatives of both Federal and State Governments. By way of introduction, the Strategy document described the huge personal and economic burden of pain in Australia, the problematic current state of pain management, the barriers to improved outcomes, and a strategy aimed at solving the problem.
What exactly is the burden of chronic pain? Access Economics’ pivotal cost analysis is ageing but remains compelling: one in five Australians, about the same population as Sydney, suffers from chronic pain that reduces their quality of life. Chronic pain cost Australia AUD 34 billion in 2007 – AUD 7 billion in direct healthcare costs; AUD 11. billion in lost productivity; AUD 11.5 billion in burden of disease; AUD 2.6 billion in ‘deadweight losses’ – welfare payments and lost taxation revenue.
