One in five Australians suffer the debilitating, long-term effects of chronic pain and a good portion of them rely on insurance payments to support their journey back to work.
Using new techniques developed by pain scientists, a world-first trial between insurer AIA Australia and researchers from the University of South Australia has changed the insurer’s approach to helping customers living with persistent pain and has been touted as a game changer for the industry.
The ‘Chronic pain in Australia’ report released in May shows pain that lasts beyond the normal healing time after injury or illness – generally three to six months – affects 1.6 million Australians, or one in five people.
The latest Australian Institute of Health and Welfare (AIHW) data, from 2016, says people with chronic pain are more likely to experience mental health issues such as depression and anxiety, sleep disturbance and fatigue, are on medication and have seen a range of health professionals from GPs, medical specialists, psychologists, physiotherapists and social workers.
Translate this to the insurance sector and it has become a major pressure point as AIA Australia national wellbeing manager Simonie Fox explains.
“Approximately 50 per cent of AIA Australia’s group income protection claims are for chronic pain and 43 per cent of our group TPD claims are for chronic pain,’’ Fox told Investment Magazine’s Group Insurance Summit in August.
“We know that we have many customers who lodge a claim for a musculoskeletal condition, but they become stuck on claim and these claims have been historically very challenging to manage from a recovery perspective.”
She says a typical insurance customer with lower back pain will likely have been prescribed pain killers, often opioids which are highly addictive, had extensive physiotherapy or another passive modality treatment before they lodge a claim.
“They may have been referred to an orthopaedic surgeon and have either had spinal surgery or are on a waitlist for spinal surgery. This is despite the fact that we know that the majority of spinal surgeries are not evidence based,’’ she says.
Fox says these customers often feel depressed or anxious and feel their lives spiral out of control.
“The health system is often failing them and has not always caught up with the pain science,” she says.
Enter pain scientists Professor Lorimer Moseley AO (main picture), Dr Vanessa Glennon and Dr Emma Karran from the University of South Australia who collaborated with AIA to trial pain education in the claims environment.
The trial included educating case managers on the best way to communicate with clients before the university embarked on six pain coaching sessions with them.
Fox says the insurer saw “phenomenal” results one month after introducing pain coaching sessions to customers. Customers’ visual analogue pain scale (VAS) reduced in 33 per cent of customers after treatment, while there had been a 44 per cent increase in the patient specific functional scale (PSFS) showing more people had increased their activity.
Fox says those in the trial had a reduction in pain severity and interference with results observed with improvement in general activity, mood, accomplishing goals and living a normal life.
The results showed 44 per cent showed improvement in doing some form of work and socialising with family and friends.
She says trial participants revealed “immense gratitude” for being able to take part in the Pain Coach program; to the coaches for their expertise, guidance and empathy; and for the self and rediscovery that participation had enabled.
“A quote that sums up the general feedback that was provided was ‘thank you so much for helping me start my journey back to being myself again’,” Fox says.
“We’re literally helping people get their lives back and improving their ability to function physically which in turn helps them in their return to work journey.’’
The insurer now has 409 people receiving coaching with 170 completing five sessions.
“Pain coaching has revolutionised the way in which we support customers experiencing musculoskeletal conditions with their recovery,’’ Fox says.
“If we are able to get better health outcomes, we will not only achieve a fantastic outcome for members, but we will also create a more sustainable product with a better claims experience.”
Professor Moseley says the trial was “one of the most exciting things we’ve been able to do” in its recent research and expected outcomes to continue improving for AIA clients.
“I want to flip your idea of pain so that you can understand why we’re doing the things that we’re doing with people in pain to help them recover and help them get back to work,” he told the Group Insurance Summit.
“It’s almost certain that your current understanding of pain is not consistent with a contemporary understanding of pain which has been revolutionised in the last 20 or 30 years.
“This is very exciting for people in pain and for those of us trying to improve the lives of people in pain.”
Moseley says this new understanding of pain is best illustrated by the encounter he had with a woman from Zurich, in Switzerland, who had been born without arms but, by her 40s, had developed “very intense, disabling, distressing phantom hand pain in both hands”.
“The key point of this is that pain, unlike fear, is always something that you feel in your body. You don’t even have to have that body part to feel pain in that body part.”
“Pain is not about detecting tissue pathology. Pain is a protector. It changes your behaviour in order to protect the body part that works so that you can make a decision to get their body part out of danger,’’ he says.
“What we now realise is that the system is responsive to training so that we can retrain our system to be less protective.”
Moseley says the best treatments for chronic pain are not drugs, surgery or electronic devices but those grounded in good education.
“Where this is really important for you people in the insurance space is that you’re spending a lot of money on clients who are disabled by persistent pain. What’s really important is pain is not a response to persistent injury it is always overprotective,’’ he says.
The best chronic pain treatments are active – things people do, such as meditation or exercise – rather than those which are done to them – such as massage or physiotherapy.
“We’ve moved away from pain being treated by therapists or an intervention, to where a person is coached to recovery,’’ Moseley says.
“It’s no longer trying to manage things as best you can; we don’t believe that anymore.
“From my perspective as a professor of pain science, I’m passionate about people in pain taking a journey of recovery. It’s exciting.”
So encouraging to see AIA listening to the experts on the cutting edge of research here. I have seen hundreds of TPD medicolegal reports where chronic pain is the sole reason that someone is classified as totally and permanently disabled, and therefore their belief is “I will never work again”. Its almost a self fulfilling prophecy. Pain as a protector is also the reason so many people who have experienced childhood trauma, PTSD, and chronic anxiety have chronic pain that does not respond to traditional approaches to pain management. It’s a revolution we are seeing here in our understanding. Bring it on!!