The burden of persistent pain – roundtable findings

"Chronic Pain costs more than cancer and diabetes combined. Living with chronic pain can be devastating and is a significant cause of depression. It’s alarming to think that one in four people experience persistent pain but that’s the reality”, says Professor Lorimer Moseley, clinical scientist, author, pain expert from the University of South Australia and founder of Pain Revolution (a community based educational program educating educators on better chronic pain management for their patients).

In a recent roundtable hosted by Investment Magazine and supported by AIA Australia, a group of business leaders from across the super and insurance industries gathered to discuss the burden of persistent pain.

The goal of this discussion was to better understand how pain works and discuss how each organisation represented at the table could play a role in patient recovery.

Here are some of the key takeaways:

It’s often the behaviour of those assessing and treating pain, and even those handling claims, that most significantly affect the course a patient takes. This behaviour has become ingrained and needs to change.

“I’ve shifted a big chunk of my focus to the community. We want patients to drive their treatment by just [thinking], ‘If I hurt my back, I want to ask my health professional the right questions.’ They can ask their GP these questions and we can give them [doctors] the answers. That’s the idea behind the pain revolution,” says Moseley. 

That means before claim time, when they’re receiving many inputs about their pain, including medical diagnosis, assessment and ultimately treatment. Each interaction affects how a person feels about their body and the insurance system tends to reinforce these feelings through its processes and language, sometimes to the detriment of recovery.

The misreading of symptoms and subsequent treatments are taking patients down a precarious road. Pain often persists with these patients and sometimes heightened by the health and insurance industries as they search for explanations with scans and the like to confirm the diagnosis thus reinforcing that there is physical pathology which is causing the pain. As an insurer we need to be careful how we communicate with our members so we don’t contribute to their pain. Our language can have an impact on health outcomes.

In his years of research, Moseley has found that pain is not an accurate measure of tissue health but rather is a protector. In other words, the unpleasant feeling of pain is simply a signal to try to change behaviour to help avoid injury. “We know that without a doubt, danger in your tissues is neither sufficient for pain nor necessary for pain,” he said. “But danger detection is very influential.”

Indeed, pain can sometimes be overprotective, giving the body unnecessary warning signals. These signals can be conditioned over time as the body learns pain, meaning pain can increase in certain people when given the right stimuli. Amazingly, the body can also create pain without any physical stimuli and this distinction is critical to both insurance and society’s handling of persistent pain.

Part of solving the problem is identifying people who have chronic pain. The diagnosis is usually the pathology which has largely healed i.e. a fractured bone. However the pain continues. There is an opportunity to code these conditions as chronic pain after it’s treated so that these people receive the right intervention. “You guys can do something about this,” Moseley said. “I imagine your businesses are paying for a big chunk of the burden because the biggest costs are related to productivity. The costs for loss of income and treatment are substantial.”

Moseley called for a new approach to reducing pain, mostly around retraining pain systems. Increased movement and exercise, among other things, were mentioned throughout the discussion as central to helping patients rehab.

It would be challenging to reshape the way the industry handles persistent pain but there are things everyone can do. The goal for us is to work together to see how we can do this better.

“It’s really about how you get that education piece happening and how you get employers to understand as well. For example, if a super fund sees a large employer where the majority of claims come in, you can start to look at intervention,” Moseley says.