Ms Cathy Sexton:

I wanted to address Deputy Ó Caoláin’s question on midwifery, staff nurses and registered general nurses. There is a difference between acute and chronic pain. I do not wish to get into definitions but acute pain is short lived and chronic pain is greater than three months. That is basically how we diagnose it. A number of conditions cause chronic pain. Surgery is probably the one that comes to mind. If one has surgery, when one signs the consent form one of the things one is signing for is that it might result in long-term pain. Often, in the acute hospital setting when patients come in and have their surgery if pain is not well managed at that stage it can lead to a chronic pain condition in the future for the patient. That means the GP will have to pick up and manage it when the patient is discharged.

In pregnancy women come in with pain which has to be managed. That can be a huge difficulty for us because of medication management and the use of medications in pregnancy. We have a high percentage rate of caesarean sections in this country, and internationally the way things are going, and a high rate of pain can be associated with the post-caesarean section stage. We also have quite a lot of pelvic conditions associated with women’s pain, including chronic pelvic pain. I will not go into the conditions in detail now but issues arise for women both in the maternity setting and post their treatment in maternity services.

From the point of view of nurses managing pain both in a hospital setting and a primary care setting, one of the main reasons patients attend a health care system is because of pain. The assessment and management of pain is a huge part of our role in every single health care setting. When patients present with pain we have to try to manage it. If it is acute pain we generally have a very good team around us that can manage it very well for the patient. We try to find a causative reason for the pain. With chronic pain sometimes we do not have a causative reason for the pain. We talked about fibromyalgia and some of the chronic conditions that cause pain but then there are some pains for which we really do not have a reason, but the patients still have it and they still have pain sensations and must live with it over a long period.

For us it is about managing diseases such as diabetes and arthritis and other conditions associated with chronic pain. The big area is care of the elderly and the amount of pain conditions that are associated with the ageing population. The other cohort of patients is patients post-cancer treatment. Pain is one of the side effects of the treatment. Another area relates to the condition itself causing pain. We also have the whole area of palliative care and end-of-life care. There is a large cohort of pain conditions associated with chronic pain.

In response to Deputy Mitchell O’Connor’s question I wish to refer to the hub and spoke model. A number of countries have developed strategies and models of care such as Australia, the United Kingdom and we also have one in Scotland and in Northern Ireland. There are different models being used and there is a lot of research related to what works and what does not work. We have good evidence to say that if one has major pain centres that deal with the interventional therapies that we require and if one needs an interdisciplinary team to manage patients’ pain, that should be done in the hub hospital. If we are talking about stratifying services in Ireland, and we are looking at hospital groupings, the main hospitals should have the multidisciplinary team working there. In primary care we are talking about having a cohort of allied health professionals, nursing and GP services managing with very structured processes. That is why we need the strategy; so that we are all educated and trained in management. That is what they have done in these countries. They have educated GPs, nurses, physiotherapists, occupational therapists and psychologists - the whole team - to be able to manage pain better and to be able to interface with those patients at a much earlier stage.

It does not mean that every patient needs interventional therapy or a multidisciplinary team, but a cohort of patients will always require that. I will let some of the other speakers talk about that, but for me the hub-and-spoke model would give us an idea of what we are looking for in a strategy. I do not think we have a cost analysis done on that, but I will let the other speakers talk about it.

Deputy McLellan asked me about the British model. Many countries have strategies on pain management, including America, Canada and Australia. The United Kingdom, Scotland and Northern Ireland have a strategy also. In that respect, therefore, we have a good deal on which to work. In terms of the cost benefit, what we see is that waiting times for patients to see a specialist have been reduced. If I am correct it is about 28 weeks in the UK, whereas in my area one could be waiting up to three years to see a pain consultant. That is the difference, and that is the point I was trying to make. I thank the committee for allowing me an opportunity to address it.