Pain

Pain is nearly universal, contributing substantially to morbidity, mortality, disability, and health care system burdens.^1,2

Pain is the most common reason for emergency department visits and is commonly encountered in primary care, other outpatient, and inpatient settings.^2,3,4

Prevalence of pain in Australia^1-5

One in five Australian adults are estimated to live with chronic pain (daily pain for more than three months, experienced in the last three months) . This is consistent with global burden of disease data, which show that lower back pain was the leading cause of disability globally in 2017 . Four million Australians currently live with arthritis, and this is projected to rise to million by 2030.

Some pain conditions are more prevalent in rural communities, with people outside the major cities reported to be 23% more likely to have back pain, rising to 30% for residents aged 55 to 64.

Chronic pain is even more common among Australians aged over 65, with one in three living with chronic pain. Up to 80 percent of residents of aged, cared facilities are living with persistent pain, which is often under-treated or poorly managed.

Between 25 to 35% of children and adolescents experience chronic pain.

The growing pain burden⁵

Chronic pain affects more than 3.24 million Australians. Painaustralia’s report, The Cost of Pain in Australia by Deloitte Access Economics, provides the most comprehensive analysis of the financial impact of chronic pain in Australia to date and it found more than 68% of people living with chronic pain are of working age. Without action, the prevalence of chronic pain will increase to 5.23 million Australians (16.9%) by 2050.

By 2032, it is projected that the number of cases of arthritis and other musculoskeletal conditions will increase by 43% to 8.7 million and affect over 30.2% of the population. Osteoarthritis is projected to affect three million people (up from 1.9 million), back problems to affect 3.8 million people (up from 2.9 million) and osteoporosis to affect 1.2 million people (up from 0.8 million).

Pain carries a significant economic cost⁵

The Cost of Pain report has pulled data out of the health, aging and disability sectors, to reveal the staggering cost of chronic pain to taxpayers. In 2018, this figure was $139.3 billion. This was on top of the fact that Australians paid $2.7 billion in out of pocket expenses to manage their pain, with costs to the health system in excess of $12 billion. There were estimated to be 9.9 million missed workdays due to chronic pain each year in Australia in 2006.

Chronic pain is estimated to be Australia’s third most costly health condition in terms of health expenditure, noting musculoskeletal conditions are the second most costly, and injuries the fourth (both carry a strong association with chronic pain).

Acute pain usually lasts for less than 7 days but often extends up to 30 days; for some conditions, acute pain episodes may recur periodically. In some patients, acute pain persists to become chronic. Acute pain is ubiquitous following surgery.¹

Acute pain management involves selection of interventions to provide adequate pain relief, in order to improve quality of life, improve function, and facilitate recovery, while minimizing adverse effects and avoiding overprescribing of opioids. Evidence also suggests that adequate acute pain treatment may mitigate factors that promote the transition to chronic pain.^2,3,4

Acute pain is considered to last up to seven days, with the following qualifications:⁵

1. Its duration reflects the mechanism and severity of the underlying inciting event.⁵
2. Prolongations from seven to 30 days are common.⁵
3. Prolongations beyond the duration of acute pain but not extending past 90 days post onset/-injury are common. This refers to the ill-defined but important period of "subacute" pain that warrants further specification and consideration in future taxonomic, research, and regulatory efforts.⁵
4. Our understanding of pain mechanisms is currently insufficient to link these durations to specific physiologic mechanisms.⁵

Episodes of acute pain may result in chronic pain with subsequent impact on quality of life, employment and mental health. The prediction and prevention of transition to chronic pain may therefore convey health and economic benefits.⁶

What is arthritis?

Arthritis is an umbrella term for a wide range of inflammatory conditions affecting the joints. This often results in pain, stiffness, swelling and redness in affected joints. Age, overweight and obesity, injury and genetic factors increase the risk of developing arthritis. Osteoarthritis, rheumatoid arthritis and gout are common types of arthritis.

How common is arthritis?

Arthritis – including osteoarthritis, rheumatoid arthritis and ‘other type and unknown’ – affected an estimated 3.7 million (15%) people in Australia, according to self-reported data in the 2022 Australian Bureau of Statistics (ABS) National Health Survey (NHS) (ABS 2023).

In 2022, the prevalence of arthritis:

• Was higher for females compared with males, apart from those aged 25–34.
• Mainly affected older people – 49% of those aged 75 and over were estimated to be living with arthritis.
• Was highest for people living in Inner regional areas and lowest for those living in Major cities (20% and 13%, respectively).
• Was highest for people living in areas of most disadvantage (lowest socioeconomic areas) and lowest for those living in the least disadvantaged areas (highest socioeconomic areas) (18% and 12%, respectively) (Figure 1) (ABS 2023).
• After adjusting for different population age structures over time, the prevalence of arthritis changed little between 2001 and 2022 (14% and 15%, respectively. (ABS 2023).

Osteoarthritis and rheumatoid arthritis are the most common forms of arthritis:

• Osteoarthritis is a chronic condition characterised by the deterioration of the cartilage that overlies the ends of bones in joints. Around 2.1 million (8.3%) people in Australia were estimated to be living with osteoarthritis, affecting 10% of females and 6.1% of males in 2022
• Rheumatoid arthritis is a systemic autoimmune disease where the body’s immune system attacks its own tissues. Around 514,000 (2.0%) people in Australia were estimated to be living with rheumatoid arthritis, affecting 2.5% of females and 1.6% of males in 2022