New formats needed 
Clinical trial data released this year in a study of cisgender men, transgender men, transgender women, and nonbinary individuals who have sex with partners assigned male at birth showed that using lenacapavir results in a 96% 
‘In my view, it’s analogous to dispensing a new drug that you haven’t come across before. You understand the relevant information related to the drug from a safety and effectiveness point of view, you communicate with the patient regarding relevant counselling points, and you document relevant information.’
Around 3.24 million Australians are suffering from chronic pain daily, costing the economy $139.3 billion in 2018, a new report by Painaustralia has suggested.1
The report, produced in conjunction with Deloitte Access Economics, measured the impact of chronic pain by analysing data from the health, ageing and disability sectors.
If the healthcare system does not change its approach to managing chronic pain, the number of Australians afflicted will rise to 5.23 million by 2050 (with 68% of sufferers being of working age). Lack of change will also see the economic cost of chronic pain soar to $215.6 billion by 2050.1
But it is not just the economic burden of chronic pain that will continue to impact the community – it is the sustained impact on mental health. Almost half of the Australians living with chronic pain (45%) now also live with depression and anxiety. This number will rise to 2.3 million by 2050.1
‘Restricting the activities people can undertake, chronic pain can reduce a person’s ability to work, disturb sleep and cause fatigue, and have a detrimental impact on relationships,’ said Associate Professor Malcolm Hogg, Head of Pain Services at Melbourne Health, and Painaustralia Director.
Associate Professor Hogg also noted that the rise in deaths associated with prescription opioid use in Australia indicates that chronic pain is not being adequately addressed.
The report suggested an investment in GP training programs and multidisciplinary care could vastly reduce the economic burden of chronic pain as well as lead to a decrease in prescription opioid-related deaths. But an investment in pharmacy services and expertise would also help to ease the burden of chronic pain.
Pharmacist upskilling
As identified in action seven in the Pharmacists in 2023 report, specialisation and advanced pharmacy practice will help to address existing and emerging health challenges in Australia. As the Painaustralia report identifies, chronic pain is a significant burden. While a national approach to workforce planning, formal recognition of practitioner development and a consistent and inclusive approach to collaborative care is necessary, pharmacists can take control of their own development.
Pharmacists need to be aware of pain resources to refer patients to, such as those offered by Painaustralia, Chronic Pain Australia or PainWISE. There are also pain management programs linked to Primary Health Networks (PHNs), such as PHN North Coast or the Pain Management Network (both in NSW), or the Persistent Pain Program on the Gold Coast.
Through the sixth Community Pharmacy Agreement, PSA has supported the Chronic Pain Medscheck Trial – developing guidelines, support tools and modules to help patients self-manage their chronic pain and improve their quality of life. PSA also provide CPD modules for pharmacists to educate themselves about chronic pain, such as Overview of pain and pain management: Part 2 – Chronic Pain.
Supporting patients with chronic pain
The report stated that the misuse of opioids has been labelled a major health crisis in Australia and internationally, and there have been increasing calls to address opioid use as part of chronic pain management.1
The use of real-time prescription monitoring systems in pharmacies, such as SafeScript in Victoria and DORA in Tasmania and the ACT, can improve clinical decision-making and help to identify and prevent medicine misuse.2 SafeScript was recently launched across Victoria, a move welcomed by PSA.
‘Pharmacists and prescribers play a vital role in using SafeScript to improve patient safety by reviewing their patients’ prescription history for high-risk medicines,’ PSA Victorian President Benjamin Marchant said in a statement.
‘Technological improvement in pharmacist care through systems such as SafeScript allows us to make full use of pharmacists’ skills and improve the health of all Australians. Ultimately, SafeScript saves lives by empowering pharmacists and other healthcare professionals to work together to protect the community from risk of overdose.’
When patients come into a pharmacy for an opioid prescription, pharmacists are well-positioned to identify symptoms of anxiety and depression that could be an undiagnosed condition or linked to chronic pain. This includes being alert to physical, psychological and behavioural signs and symptoms of anxiety and depression such as avoidance of situations which cause anxiety, increased use of alcohol or sedative medicines, indecisiveness, fatigue or fear.
Pharmacists can refer patients to BeyondBlue where they can complete checklists to monitor their mental health or get support through online forums, national helplines or find a local mental health professional. Pharmacists can also refer patients to crisis services such as Lifeline or suggest that they see their GP for a referral to a specialist.
References
- Painaustralia and Deloitte Access Economics. The cost of chronic pain in Australia. March 2019.
- Boyles, P. Real-time prescription monitoring: lessons from Tasmania. Aust Prescr 2019;42:48-9. 1 April 2019. At: https://www.nps.org.au/australian-prescriber/articles/real-time-prescription-monitoring-lessons-from-tasmania
