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Pain medicine specialists on Mental Health/Addiction inquiry

Specialist Pain Medicine Physicians have welcomed the Mental Health and Addiction inquiry report as a stepping stone to addressing causes of, and finding better solutions to the mental health crisis facing this country.

“There’s no doubt mental health and addiction is complex, as are the solutions, and the report is testament to the strength of feeling and the need to be heard as expressed in the summary,” says the chair of the Faculty of Pain Medicine (FPM) New Zealand National Committee, Professor Edward (Ted) Shipton.

However, Professor Shipton says it has to be understood that people struggling with ongoing pain are part of New Zealand’s mental health landscape. “FPM expects more emphasis on the burden of ongoing pain will be made in actions arising from the inquiry.”

One in five New Zealanders live with ongoing pain, yet there are limited resources to help them. In New Zealand, latest figures show four of the leading six causes of disability are chronic pain conditions (chronic low back pain, migraine, chronic neck pain and other muscular-skeletal disorders). The other two are anxiety and depression. Epidemiological studies suggest that a bidirectional relationship exists between ongoing pain and anxiety and depression.

Although short-term pain is a useful protective warning of damage to the body, ongoing pain usually is not helpful, and becomes destructive instead. It continually activates our body’s stress systems. This can further amplify pain signals. The result can be anxiety, low mood and depression, and memory difficulties. When not well managed, this can lead to sleep problems, further stress, relationship breakdowns, loss of income, and early retirement.

Evidence based management of ongoing pain requires a multidisciplinary team approach, and input that includes a targeted mental health approach and addiction management.

Professor Shipton says that the establishment of more multidisciplinary pain clinics and the training of more specialist pain medicine physicians can help people with co-morbid ongoing pain and mental health conditions, before they become another mental health statistic.

In its submission to the inquiry, FPM pointed to the shortage of specialist pain medicine physicians, with approximately eleven full time equivalent (FTE) positions nationally.

Internationally, it is recommended that there should be one specialist pain medicine physician per 100,000 people, which would equate to approximately 47 FTE positions in New Zealand. The shortage of specialists and limited number of training positions means patients with complex ongoing pain issues can face significant waiting lists, or not be referred for specialist services at all.

As an example of unmet need and late intervention, ‘The Auckland Regional Pain Service’ has found that patients, who are referred to its three-week pain programme, have on average already been living with ongoing pain for 8.5 years.

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