Professor Laserina O'Connor:

The Irish Pain Society is a group of clinicians of all disciplines who are committed to making a difference for the person in pain across the continuum of care. People with chronic pain can find interacting with the health care system complicated and stressful and it often results in high use of health care services and unrelieved pain. It has been shown that across Europe, one quarter of people have to wait up to five years to receive a diagnosis or reason for their pain and a further 11% must wait longer to receive a diagnosis and treatment. The impact on quality of life is an issue. Chronic pain rates are likely to rise for several reasons such as the ageing of the population which means that a growing number of people will experience the disease with which chronic pain may be associated such as diabetes, cardiovascular disorders, arthritis, stroke and cancer among others. The increasing presence of obesity is also associated with chronic pain conditions and painful symptoms are associated with diabetes and associated neuropathy and osteoarthritis.

We have made great progress in saving the lives of people with catastrophic injuries but this creates a group of relatively young people who are at risk of lifelong chronic pain. People who are survivors of chronic illness such as cancer may develop neuropathic pain related to chemotherapy. All surgical patients are at risk of acute and chronic pain and several of those patients may develop a persistent pain and 20% of those patients may become new chronic pain patients. Greater public awareness is required. Chronic pain is a public health challenge.

The Irish health care system is undergoing profound changes. Health care reform can offer new opportunities for the more effective prevention and treatment of pain. In prescribing the basket of health care services, the Government's White Paper on the path to universal health care 2014 recognises health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Adequate pain relief lies very comfortably with that definition as does rehabilitation for chronic pain.

Chronic pain can be conceptualised as a public health challenge for a number of reasons. Mr. Lindsay alluded to the fact that one in five people may experience chronic pain. New statistics inform us that one in three people may experience chronic pain and that they may endure this pain for anything up to 20 years and at the least for five years. Substantial disparities exist in the management of chronic pain and the vulnerable population includes older persons and the cognitively impaired. The cost to the system in caring for them is a cost to the nation's economy.

There are social, economic and physical environments which need to be addressed with regard to this pain. Chronic pain is costly to the nation and it can cost €5.34 billion annually, which is 2.86% of GDP. Opiad and analgesic medications for pain could be subject to misuse and abuse and cross-departmental actions may be required to deal with this problem.

Professional education may be required because education is central to the necessary cultural transformation of the approach to chronic pain. Public health offers a great strategy for countering the misunderstanding that hinders the management of chronic pain. An interdisciplinary approach is required. I refer to Australia where a national pain strategy has been created. It is a 94-page document which emphasises the need for co-ordinated interdisciplinary assessment and management involving at a minimum physical, psychological and environmental risk factors for each patient, recognising that interdisciplinary care has the strongest, evidence-based information and should be available at all levels.

There are two group-based public multidisciplinary programmes in Dublin for chronic pain patients. The research community should pursue pain research with the same vigour expended on other serious and disabling chronic conditions. The origins of chronic pain are in musculo-skeletal conditions as well as conditions such as headache, arthritis, migraine, fibromyalgia, visceral diabetes, cancer and shingles. It is important to note that one patient may have several causes of his or her pain. Mr. Lindsay has provided the testimony of patients and I refer the committee to appendix No. 2 of the submission which contains a testimony of living with chronic pain. That testimony demonstrates that a sufferer of chronic pain may make seven to ten visits to a GP in one year but research has shown that 38% of patients reported that their pain was not adequately treated. Appendix No. 3 demonstrates the prevalence of chronic pain in Europe. In 2006, Ireland had a rate of 13% but now, 25% to 35% of adults experience chronic pain. I refer to the emotional toll of chronic pain and the four Ds which are disability, despair, depression and disuse.