The pain revolution

By

07/06/2018

It’s alarming to think that 1 in 4 people experience persistent pain but that’s the reality, says professor Lorimer Moseley, clinical scientist, author and pain expert from the University of South Australia.

He uses the term ‘persistent’ to shift the common view of chronic pain as something to fix. There’s a subtle difference: persistent pain lasts longer than perhaps expected and by framing it this way, people in healthcare can move away from quick fixes and open up new possibilities for rehabilitation.

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.

That burden includes significant financial and productivity costs for insurers and the economy at large, but even more worrying is the impact of mental health issues suffered by those with ongoing pain.

The goal of this discussion, therefore, was to better understand pain and discuss ways each of the organisations represented at the table could play a role in patient recovery.

A massive challenge

Moseley firstly talked about the science behind persistent pain and how the insurance industry can do its part.

There’s no easy solution because, as Moseley explained, it’s often the behaviour of those assessing and treating pain, and even those handling claims, that most significantly affects the course a patient takes. This behaviour has become ingrained and needs to change.

“I’m convinced in my belly that the health field has made a significant contribution to the burden of persistent pain,” Moseley said. “We’ve made a lot of mistakes, most obviously with opioids. But my field of physiotherapy has also made a lot of mistakes pathologising stuff that shouldn’t be pathologised.

“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.”

Moseley emphasised the power of our own physical systems to protect us. Better understanding this power is vital to creating a positive change in the way we help patients interpret and recover from pain.

Everyone agreed that change must start early in a patient’s journey. That means before claims 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.

Chief group insurance officer at AIA, Stephanie Phillips, said that for many people the injuries aren’t purely physical, and this is crucial to the pain puzzle. “From an industry perspective, we need to influence people in a more positive way,” Phillips said.

“This is a huge opportunity to support the pain revolution – to understand that we can reward people for their health, not just [before claims, but afterwards] as well. We have to incentivise people to get healthy.”

This is where language plays a role. For example, ANZ Wealth head of life insurance Gerard Kerr noted that there’s no category for pain in claims and that this needed to be addressed. “That’s a lightbulb moment for me,” Kerr said. “We can do more. We’ve run away from mental illness claims because they’re hard to deal with, which is so wrong. We should gravitate toward risk and offer solutions.”

Director, health benefits of work, strategic research and innovation group at Comcare, Megan Buick, said she’s interested in learning how to have better interactions with patients. She added that the industry could look at both policy and behavioural changes, along with early intervention, when it comes to pain. “The [health] system doesn’t operate as a system but in silos,” Buick said.

“There are gaps for patients. So, there are things we need to think about in this discussion, including the power of the individual and that there are also so many different practitioners [handling patient-related pain].”

Asking the right questions

Everyone at the table agreed that the misreading of symptoms and subsequent treatments are taking patients down a precarious road. Pain often persists with these people, largely because of the way the health and insurance industries label what they’re feeling.

This can typically lead to psychological or emotional pain, too. To this end, NGS Super company secretary and manager of insurance and complaints, Bernard O’Connor, stressed the impact of physical pain on the mind by sharing a personal story of being hit by a motorcycle.

“I asked myself, ‘Why did that happen?’ Why me? Why am I experiencing such intense pain? I have to get back to work,” O’Connor explained. It’s this type of self doubt that can turn a physically painful experience into much more, including anxiety and depression. Mental health can be affected following an injury on the job, too.

Executive manager, insurance, at Mine Super, Daryl Bull, offered that while many insurance claims from coal miners are for back injuries, about half of those people also have mental health issues. He was, therefore, pleased to learn more from Moseley and talk about his process for helping these types of patients.

“I want to take back the most contemporary thinking on this [to the business],” Bull said. “We want to get people in the 30-to-40 age group feeling good and back to work, rather than say, ‘Don’t do anything, we’ll get you a payment for the rest of your life.’ ”

Similarly, HESTA insurance and resolution manager Tracey Allan said her business sees many chronic back pain claims, so she’s keen to improve the experience for her members, of which there are 843,000 working in aged care and hospitals. “What we do now [in the healthcare industry] doesn’t work,” Allan said. “We have a lot of people with old mindsets.”

For example, she noted there’s been a shift from the older generation of healthcare workers to the new generation, where they have a better understanding of pain issues and how to tackle them.

This is encouraging. Furthermore, BOC superannuation operations manager, South Pacific, Nathan Bell, said his organisation was keen on early intervention but wanted to explore other ways for the fund’s insurer to help in this mission. “If we know the [right] questions, how do we get them to our members or claimants?” he proposed.

Educating the nation

Exphys rehab director and exercise physiologist Chris Sinclair was on hand to help explain how the financial services industry can help educate society about persistent pain. “It all comes back to creating a sense of safety through education,” Sinclair said. “It’s hard work and can be fatiguing but we can give someone the freedom to move and engage in proper movement patterns and start to restore their function for work and life.

“When someone has negative thoughts, we’ll actually give them that connection physiologically or biologically about how that input is reacting on their system.”

Moseley added that the brain was central to this task. “It’s absolutely intimately related to protection,” he said. “All of this comes down to the drive to protect yourself. Some brains produce pain, others depression, anxiety, fear or stress. Some will produce the whole lot. But if your brain is in the habit of producing mental healthiness, that’s significant for your protective meter.”

Pain and depression

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.

“We know that if you develop persistent pain, you can increase your risk of depression eight-fold,” Moseley said.

“We know that with some persistent pain disorders, your risk of attempting suicide is enhanced 25 times.” Moseley drew a few gasps when he added that the persistent pain burden costs the US more than its wars. It’s a massive burden by any measure, including for the super and insurance industries, he said.

Part of solving the problem is recoding an injury months after it’s treated. “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.”

Finding solutions

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.

AIA group strategy manager, rehab and claims, Simonie Fox, added that 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 with the industry to see how we can do this better,” Fox said.

“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. You can say this employer has the majority [of claims] so you can dive in and create a strategy for them.”

Getting the message out

The main issue for the super and insurance industries is that the message is not reaching those at the coal face, such as medical practitioners and claims teams. “Insurance has to move forward and we have an obligation to work with the government and mental health organisations to improve the processes we have as insurers,” AIA’s Phillips said.

“We want to collaborate with partners who can help us. Our organisation has a commitment to mental health issues in the industry and we’re working toward being a change agent in this.”

Change is happening, although it will take more work on the ground, Moseley said. He’s been educating doctors and others in the field who typically rely on treatment instead of retraining and rehabilitating the body. UniSuper manager, insurance claims, Alison Devitt suggested that those providing pharmaceutical treatments need to be brought into the fold to become a bigger part of the solution.

While Moseley is continually trying to educate GPs, he said the focus should ultimately come back to patients, families and the wider community. “We need to have some sympathy for a GP who has 10 minutes when someone is suffering and can either embark on a journey of complexity and retraining the system or write a prescription,” Moseley said. “What would you do under the pressure?

“This is the problem with partnering with people who have a treatment to sell. That’s why I’m excited to deal with organisations that have recovery to sell. We’re not trying to achieve treatment, we’re trying to achieve recovery.”

Participants

TRACEY ALLAN Insurance and resolution manager, HESTA

NATHAN BELL Superannuation operations manager, BOC South Pacific

MEGAN BUICK Director, health benefits of work, strategic research and innovation group, Comcare

DARYL BULL Executive manager, insurance, Mine Super

ALISON DEVITT Manager, insurance and claims, UniSuper

SIMONIE FOX Group strategy manager, rehab and claims, AIA Australia

GERARD KERR Head of life insurance, ANZ Wealth

LORIMER MOSELEY professor, author and co-author, Explain Pain

BERNARD O’CONNOR Company secretary and manager, insurance and complaints, NGS Super

STEPHANIE PHILLIPS Chief group insurance officer, AIA Australia

CHRIS SINCLAIR Director and exercise physiologist, Exphys Rehab

Chair

Colin Tate, Chief Executive, Conexus Financial

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