PMH – How Pain Services Can Be Even Better for Young People in WA

Elizabeth Benton is a psychologist specialising in working with young people who live with persistent pain. She is Director of the new Remedy Pain Centre in Fremantle. In this interview she speaks to Julia Sutton about the missing element in pain services for WA children and younger adults, the Remedy Pain Centre and the changing focus of pain treatment.

How To Improve Pain Services

Julia:
Parents are currently lobbying for an improved pain service at PMH. What do you feel is missing in pain services for younger people in WA?

Elizabeth:
I think we need to follow what the research is showing us and start applying an integrated multi-disciplinary approach. Group education is also key. Speaking from models that I have seen work in the adult system, both at Fremantle Hospital and Nambour General Hospital, the pain team consists of health practitioners fully or partly employed by the pain department, rather than separate departments, for example physiotherapy or psychology.

In this way, the team shares a space that enables them to be geographically together as well as opens the possibility for a truly collaborative approach to the patient’s care and journey through the department. A multi-disciplinary approach is integral to the functioning of an effective pain service. Group sessions and programs focussing on education around self-management is a big part of adult persistent pain services, and to my understanding this is not offered in child services yet.

PMH Pain Clinic

Julia:
PMH have secured funding and commenced planning for a Pain Service, will Remedy Pain Centre duplicate what they’re doing there?

Elizabeth:
I don’t believe so. Remedy Pain Centre offers a truly multidisciplinary approach to persistent pain and the focus is on self-management. We don’t employ GPs or any specialists. So we’re more an allied health service for young people with persistent pain.

The PMH clinic will help people obtain high level medical diagnosis and advice and make sure that the medication side of things is well managed. I’m certain that if the funding is available they’ll want to extend that service to give children access to a pain clinic which integrates allied health professionals as part of a dedicated pain team.

Background – Elizabeth Benton

Julia:
Elizabeth, can you please tell me a little about your work and interest in young people with chronic pain?

Elizabeth:
During my Masters of Clinical Psychology I did an internship at Fremantle Hospital Pain Medicine Unit with Carl Graham, Clinical Psychologist. I quickly fell in love with this particular field. Following the internship, I was employed by Fremantle’s Pain Medicine Unit and also started in private practice, specialising in behavioural medicine for chronic disease, which incorporated chronic fatigue syndrome as well as various general health conditions.

Following that, Queensland received a huge boost in funding to open up Persistent Pain Services. I was lucky enough to land a project management role and allied health team leader job in the Sunshine Coast region. I was helping establish their pain management service, and then training staff and delivering services to their extraordinarily long waitlist (500+).

The Human Cost of Waiting Times

Through that experience I really learned what the impact is when you make someone wait. We saw people with pain syndromes that if they’d had an appointment when they were first diagnosed with pain, they would have been so much better off. What we could have offered them would have been life changing.

This is particularly true for 30 years olds who may have lost their job, their families and now their lives had fallen apart. Many times I felt this could have been avoided, or at least minimised, had they received appropriate strategies to assist with their coping. They haven’t known about other services and what the possibilities were for resources other than traditional medication. Medication can start to become less effective over time and a negative snowball effect can happen from there.

That’s when I started to think about coming back home to Perth and treating kids who are in the same boat over here. There’s a whole heap of kids here that have been waiting ages for an appointment. They might not ever get an appointment until they’re old enough to then enter the adult system. If they do get an appointment, they might not be seeing specialists in the area of pain and paediatrics, as these health practitioners are so thin on the ground.

How Many Children Suffer Persistent Pain?

Julia:
What percentage of children experience chronic pain do you think?

Elizabeth:
Well, it depends on the literature you read. The common thought is that 20% of any population experiences chronic pain and that’s certainly been replicated in a lot of adult population studies.

About Remedy Pain Centre

Julia:
The Remedy Pain Centre has just opened in Fremantle. Can you tell me a little about it?

Elizabeth:
Remedy Pain Centre was formed because there was an area of the population that was neglected and this is a very vulnerable population. The Centre was established primarily to treat kids aged 6 to 18 years who suffer with any persistent pain condition. The target group has since extended to twenty somethings.

If you’re diagnosed with persistent pain when you’re 18 to 30, sure you’re eligible for the adult system, but when you go into that system you might be put in a group with 70 or 80 years olds which can be alarming.

If you’re diagnosed in your 20s, you might not be able to have the career you’ve always wanted or you might not be able to be in the financial circumstance that you felt you would attain. You might not be able to raise a family. These are huge identity questions that people of that age need to work through.

Julia:
What about your philosophy and motivation behind this clinic?

Elizabeth:
Our practice is evidence-based and to primarily teach the self-management side of things. If the medication is doing as much as it can, then we need to add in other specialties to help with the additional facets of pain, also known as load factors. We can help people develop strategies to deal with other factors that contribute to their pain such as; family stress, school stress, anything social, emotional or physical.

Which Groups Benefit Most?

Julia:
Who are the people that you think are most going to benefit from this service? Are you thinking certain age groups or certain conditions that will come to the clinic?

Elizabeth:
We are keen to work with people in the 6 to 30 year age range. We’ll be running different groups so people will be with their peers. I think the people that are particularly going to be benefit from this service are those young people that have been from pillar to post. They’ve seen many specialists and they’ve experienced a lot of disappointment and frustration. For whatever reason they might be thinking their pain is never going to stop or this might be as good as it gets. If people come to our centre we can do a thorough assessment, offer integrated OT services, psychological services and physiotherapy both individual and group.

Changes In Pain Treatments

Julia:
Pain treatment strategies are changing all the time. Can you talk a little about the changes that you see?

Elizabeth:
There’s a move toward a more holistic approach and also working with an integrated team.

Remote Access

Julia:
Can people in remote areas arrange to consult with you via Skype?

Elizabeth:
Yes, because I’m a psychologist I don’t do anything hands on and the OTs and physios don’t mobilise or manipulate at Remedy Pain Centre. The only potential hiccup may be if it’s a complex condition, such as CRPS, the person on the other end would need to get resources like the mirror boxes and the graded imagery cards. Obviously, we would talk the person through and demonstrate how to use them from our end in a therapeutic way. We can help with sourcing such resources.

Appointment Flexibility

Julia:
Children with a chronic condition miss a lot of school because of the need to attend appointments and stay home on sick days, and this can have a big impact on parent employment. Will there be any early morning, evening or weekend appointments to assist with issues of school attendance and parent’s ability to work?

Elizabeth:
Absolutely, our clinic will open at 8 o’clock in the morning and it will run through to 7 o’clock at night, Monday to Friday. Any group programs for parents and carers will take place from 7 o’clock till 9 o’clock to accommodate full-time work schedules. We are also going to be opened Saturday mornings for both individual consults and group programs.

We’re hoping on a Friday afternoon to offer an after school social support group and that might take a form of an art therapy course one term and then the next term it might be music therapy or yoga or something to get these kids engaged with a therapeutic task, build relationships, share their problems and have a facilitator there to help them with any self-management principles that they’re stumbling on, so it will be for support as well as treatment.

Referrals

Julia:
Do patients need a referral to attend the clinic?

Elizabeth:
If they would like a Medicare rebate they do. They can self-refer but then they would have to pay the full fee. If they have a GP Mental Health Care Plan, they’re eligible for 10 sessions with a psychologist or an occupational therapist as well as 10 group sessions. We’re not a bulk billing clinic but that rebate educes the gap significantly.

Julia:
Thanks very much, Elizabeth.