Dr. Josh Keaveny:

Chronic pain is a very difficult problem to deal with. It is a problem of the sensory and emotional systems. One of the difficulties with chronic pain is that there is not a definite marker for pain as is the case with other disorders. Chronic pain is recognised as a disease of the central nervous system and in time it will be recognised as a disease in its own right. In Ireland chronic pain is a silent disorder which has a significant social effect. Approximately 14% of the population is afflicted with chronic pain. The disease is a problem for the individual, for society, for families and is a significant financial burden on the country. The cost is approximately €4 billion a year which is a staggering amount. This is made up of the cost of treatment, care and loss of income. Of those who claim long-term medical disability, 70% of people quote pain as one of their main complaints. The figures show that people with chronic back pain have a less than 10% chance of ever returning to the workplace. For example, I refer to a young person in his or her 30s with chronic back pain who is married with a family.

Such a person is sent from one consultant to another before finally being transferred, 12 months, 18 months or even two years later, to a pain clinic. The chances of that individual ever getting back to work are very slim and the cost to the State is colossal.

Over time, many advances have been made in the diagnosis and treatment of pain and rehabilitation programmes for patients. When people can avail of those services in a timely fashion, the chances of their returning to the workplace improve dramatically. Unfortunately, the availability of these advances has not kept pace with services for chronic pain sufferers in this country because those services have not been adequately funded. The Irish Medical Council, following a submission from the faculty of pain medicine, recommended recently that pain medicine be given specialty status. We are waiting for the Minister to sign off on that recommendation and would be grateful for the committee's support in this regard.

Affording pain medicine speciality status would enhance our ability in the faculty of pain medicine to improve undergraduate and postgraduate education, which is absolutely crucial into the future. It would also strengthen our training and fellowship programmes, thereby facilitating the provision of doctors with specific training in pain medicine. As it stands, we are very much underfunded as health professionals with a special expertise in dealing with the complexities of pain management, with only 14 or 15 whole-time equivalent posts at consultant level for the entire country. The European recommendation is one pain specialist per 100,000 population, which would equate to the provision of 45 full-time consultant posts across the various hospitals. We are equally underfunded at all other levels, including advanced nurse practitioners, physiotherapists and psychologists. As Professor O'Connor pointed out, we have only two proper pain management programmes in the entire country.

We are calling for the appointment of an administrator within the Health Service and-or the Department of Health with whom we, whether doctors or support groups, can liaise in order to develop our funding mechanisms. A lead clinician in pain medicine should be appointed to each hospital group to liaise with the various pain departments and develop cohesive plans for each group. At the moment, many parts of the country have no pain clinics; there might be some health professionals with an interest in pain management working in those areas but there are no dedicated clinics. The small number of clinics we do have are inundated, with waiting times for new patient referrals and treatments going way beyond the nine-month limit set down by the HSE.

Since 2008, the population of this country has increased by approximately 8%, while funding for health services has declined by some €4 billion in that period. At the same time, the number of people aged over 65 has risen by 14%. The growing numbers of older people who are anxious to stay fit, active and healthy mean that our clinics are swamped. In our efforts to treat these people, the younger patients who make the greatest financial contribution to the State are not getting an opportunity to receive treatment. We would be grateful for a recognition from the committee that the problem exists and for its support in developing structures to secure funding for enhanced services throughout the country.