The pharmacological management of pain in older Australians

Nearly all humans experience acute pain during their lives. Generally, acute pain is short lived, however, up to 20% of adults globally suffer from persistent pain. This prevalence increases with age with up to 50% of elderly people in the community setting and 80% in aged care facilities (ACFs) experiencing persistent pain. Pain, whether acute or persistent can create a significant burden and cost to the patient and society as a whole, through reduced work productivity and health care costs. In the financial year ending June 2014 analgesics (excluding anti-inflammatories) were the fifth most commonly dispensed class of drug on the Pharmaceutical Benefits Scheme (PBS) in Australia. Six of the top 50 medications on the PBS, by volume, were analgesics or anti-inflammatories. The most frequently dispensed analgesics were paracetamol (with over 6.4 million prescription), followed by paracetamol and codeine (with approximately 3.8 million prescriptions) and then oxycodone (with approximately 3.7 million prescriptions). These figures parallel research findings in Australia and other countries that have found that the consumption of analgesics, particularly opioids, for persistent pain has increased dramatically over the past decades, as a consequence of significant societal reliance on the pharmacological management of pain.

With pain being so prevalent in today's society, evaluating the way in which pain is managed pharmacologically, as well as identifying quality use of medicine (QUM) issues related to its management is paramount to ensure optimal patient outcomes. In addition, increased research activity in pain management has been recommended by the National Pain Strategy [Australia] and the Royal Australasian College of Physician's Opioid Policy, with a focus on assessing attitudes to pain, risk factors for persistent pain conditions and reducing the harms associated with pain management, particularly opioids.

The overarching aim of this thesis was to identify barriers to pain management and make recommendations as to how these could be overcome.