The Australian Physiotherapy Association is calling for Medicare funding covering physiotherapy treatment for sufferers of chronic pain.

“The APA would like to see funding for a long initial assessment and then up to 10 individual or group consultations - as in the case of other chronic disease management plans - to enable to person in chronic pain to engage in either a group interdisciplinary program of individual tailored sessions incorporating exercise and education,” said APA Pain and Musculoskeletal Physiotherapist Chair Dianne Wilson.

“There is scope to manage these people via telehealth consultations, but these are currently not funded either.”

Ms Wilson said physiotherapists can help with education about pain science, supporting people with chronic pain to reconceptualize pain from being a marker of tissue damage to a protective message.

“This protection afforded by pain often becomes sensitised in chronic pain, so that the system becomes overprotective, and the person in pain stops moving or exercising, thinking that they will do more damage.

“By educating about the actual changes that take place in the nervous system and brain in chronic pain, we can encourage people with chronic pain to continue to move and exercise, knowing that they are not doing any more harm to their tissues.

“We reinforce that we are ‘bioplastic’ - that is the body can change and heal, but we need activity in order to promote this.”

Physiotherapists are ideally placed to prescribe and supervise the right sort of activity, while considering the overprotective nervous system of chronic pain sufferers.

“We also understand the complexity of pain and the multiple factors that influence its perception, including psycho-social factors.

“We are trained to recognise these factors through careful and detailed interviewing and will refer on to appropriate professionals for expert opinion and management.”

Pain is very dependent on context, and physiotherapists who are trained in pain management will have the skills to untangle the contextual issues for each person and address them in their management, Ms Wilson said.

“I think it is quite well known by the medical profession that chronic pain is complex and difficult to manage.

“However, I believe that it would be impossible in a 10 minute medical consultation for a doctor to be able to address the issues affecting the person in front of them.

“It is widely known that an Interdisciplinary approach is the most effective way to manage chronic pain, and this is often not possible in GP clinics in primary care,”

While people with chronic pain are often referred to physiotherapists for management, it’s often with the expectation that they will manage the bio-medical components only.

Ms Wilsons said this was insufficient for complex chronic pain, however time and subsequent cost limitations often prevented adequate assessment and management of the complexities.

Where pain management programs exist in primary care, GPs do refer their patients, but these programs are rare, or have large waiting lists in both primary and tertiary care settings.

“Physiotherapists definitely have much to offer in this space and would like to receive more referrals, but within a system that can support longer consultation times and an interdisciplinary approach.

“Primary care pain management may be government funded through Primary Health Networks, but failing that there is not adequate funding for physiotherapy (or interdisciplinary) management.

“Private physiotherapy costs are prohibitive for many people even if they do have private health insurance, as ongoing management is often required and will involve long consultations in order to manage the complexity of the presentation.”