With disabling chronic pain representing an under-recognised burden for at least 10 percent of Australians, University of Sydney researchers and interstate colleagues are playing a leading role in OPEN (Online Pain Education Network), a new education initiative designed to transform how pain is understood and managed nationally.
What is OPEN
In 2020, the Australian Federal Department of Health and Ageing awarded researchers and educators at the University of Sydney and Curtin University funding to develop an online training course in pain management skills for all healthcare professionals, now called OPEN (Online Pain Education Network).
OPEN is a social enterprise that translates research into impactful solutions for society as a whole. The training provided by OPEN has been carefully matched against academic research on the healthcare needs and priorities identified by people living with pain across Australia.
“The ultimate goal of OPEN is to facilitate access to the right care for people with disabling pain as locally as possible. In turn, this should lessen the demand for scarce and expensive specialist services,” says Professor Michael Nicholas, Clinical Psychologist and OPEN academic lead at Sydney Medical School (Northern).
OPEN was developed by clinicians, educators, and researchers led by the University of Sydney’s Professor Michael Nicholas, Professor Fiona Blyth, Associate Professor Elizabeth Devonshire, Dr Duncan Sanders, Dr Simone De Morgan and Pippy Walker, along with a team from Curtin University led by Professor Helen Slater, Professor Andrew Briggs, Professor Peter O’Sullivan, Dr Rob Schütze, and Dr Roger Goucke (University of WA).
“An innovative approach to this national problem is long overdue,”- Professor Nicholas.
Despite repeated calls for national action, OPEN represents the first real attempt to provide the same core training in basic pain management skills across all healthcare professionals and students in Australia. This will make it possible for people seeking help with their chronic pain to be able to access recommended, evidence-based help wherever they live.
Professor Micheal Nicholas, Pain Management Research Institute
Chronic pain in Australia
People struggling with disabling chronic pain often report feeling stuck in an endless cycle of investigations and ineffective treatments. The overuse of imaging and opioids are a cogent example of this conundrum. Yet, there are ways of helping people with chronic pain to overcome the impact of pain on their lives and there are evidence-informed pain management guidelines for healthcare professionals to follow.
“Principally, the guidelines boil down to enabling people disabled by chronic pain to develop effective self-management strategies to deal with their persistent pain in partnership with their treating clinicians,” says Professor Nicholas.
“There is a gap between evidence and practice driven by a lack of access to the recommended approaches, combined with ready access to treatments that are not recommended in the guidelines, such as more scans and opioids”.
There is also a lack of confidence amongst many healthcare professionals in their ability to work alone or with others to provide effective self-management approaches to their patients.
“The reality is that relatively few healthcare professionals have been trained to provide the recommended approaches. Traditional approaches to chronic pain typically focus on pursuing pain relief by reducing pain severity alone,” says Professor Nicholas.
“While this is an understandable goal, many of these traditional interventions are of limited value, and even harmful for some people with chronic pain, and have resulted in a demand for chronic pain care that far exceeds the capacity of current health services to provide”.
The means that many chronic pain sufferers are referred to specialist pain clinics for more comprehensive help, but despite their best efforts, their numbers are also limited and long wait times leave many people living with chronic pain in limbo and vulnerable to offers of ineffective and short-term ‘quick fixes’.
Reimagining pain care in Australia
Evidence-informed guidelines recommend that unless there is a treatable underlying condition, people living with chronic pain are best served by avoiding reliance on simple ‘pain relief’ options and adopting an active self-management approach to their pain with the support of their healthcare professionals.
Professor Fiona Blyth, from the School of Public Health at the University of Sydney mentions that as the term suggests, ‘self-management’ usually includes helping the person in pain to take control of their pain management and to work with their healthcare professionals on ways in which they can gradually resume a more active and meaningful lifestyle despite persisting pain.
"This may include overcoming fears or concerns about their pain, gaining an accurate understanding of their pain and confidence in their ability to manage it, minimising reliance on potentially unhelpful medication, and dealing with obstacles such as sleep and mood disturbances, as well as social issues such as social isolation and unhelpful work environments," says Professor Blyth.
OPEN training to change pain management
It is expected to take roughly 20 hours of self-directed learning and practice to complete the 15 modules in the course. By being online and asynchronous it means the training can be accessed from anywhere with a functioning internet, at convenient times, and paced over extended periods to fit in with other demands.
“Learning the necessary skills and how to use them requires time and dedication, but these skills will be appreciated by people living with chronic pain,” - Professor Blyth.
Once adopted by more universities and professional groups, it will complement their education about pain and significantly extend their skills in pain management. Most importantly, healthcare professionals who complete the training should find they can work collaboratively with other healthcare professionals to provide people living with pain with person-centred and consistent interdisciplinary pain management guidance – an outcome that Professor Blyth notes is conspicuously lacking currently.
OPEN will be overseen by representatives from the University of Sydney, Curtin University, the Australian Pain Society, the Northern Sydney Local Health District , and two charitable bodies, the Pain Foundation and TDM Foundation. All profits generated by the training will be directed towards the development of further training courses in pain management and clinical pain research - for which pain researchers at the University of Sydney, and elsewhere, may apply.
OPEN has received financial support from the Department of Health, Disability and Ageing, and philanthropy partners (Hearts and Minds Investments, TDM Foundation and the Pain Foundation). Support for OPEN has also been provided by Chronic Pain Australia, Pain Australia, the Pain Foundation, and the NSW Agency for Clinical Innovation (ACI).
“We’re also really excited to share that a partnership approach to dissemination of the training is being used and promoted by numerous professional bodies, including the Australian Physiotherapy Association, the Australian College of Nursing, the Australian Pain Society, the Australian College of Nurse Practitioners, and Pain Nurses Australia, with discussions underway for similar arrangements with other bodies” - Professor Blyth.
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