LEADING Hunter pain specialist Chris Hayes says the profession has “got it wrong’’ on the treatment of chronic pain and the medical fraternity owes the community an apology.
“We are trying to do a medical about-turn,” Dr Hayes said.
There has been an over-reliance on prescription opioids to treat chronic pain, contributing to climbing rates of demand and addiction, which needs to be turned on its head, Dr Hayes said.
“Ten years ago we told our patients to get on opioids, and stay on them,” Dr Hayes said. “Now we are questioning if we should issue a sorry statement over our over-enthusiastic extrapolation of the evidence.
“The evidence was there for the use of opioids to treat acute pain, but as the evidence shakes out 10 to 15 years later, we’ve realised these drugs don’t work as well as we thought. Now the buzzword is de-prescribing.”
Dr Hayes, Director of the Hunter Integrated Pain Service at John Hunter Hospital, will become the new dean of the Pain Medicine faculty of the Australian and New Zealand College of Anesthetists in May.
He and his team regularly apologise to patients as part of their initial introduction to their pain management program, he said. “I don’t think people do it enough, medically we are very defensive.’’
The focus now was on a whole-of-life approach involving “active self-management”, and re-training the brain, based on concepts of neural plasticity. Together with establishing a healthy diet, exercise, relationships and interests, patients’ experience of pain will decrease and their functionality will improve, Dr Hayes said.
“You can retrain the brain but it’s hard yards, you have to be courageous and disciplined and stay with it for six months and then you can expect (the pain) to decrease. We are trying to communicate the evidence and support people by making it safe, and doing it very slowly.
“People who have had chronic pain for 20 years can cure their pain this way, it is possible through lifestyle change.”
Dr Hayes’ team see 1000 patients per year. It is estimated that 20 per cent of the Australian population has chronic pain, about one in five, and 10 per cent have interference with their daily activities to the extent where they would benefit from a referral to a pain specialist.
“We are trying to give more advice to GPs,’’ he said.
“We shouldn’t be prescribing opioids for long-term pain. The more that times goes on, the more the body adapts and becomes tolerant to it. According to our guidelines, people should not be prescribed opioids for chronic pain without discussion with a pain specialist.”
For more information on chronic pain, visit the Pain Management Network.