Professor Laserina O'Connor:

If I give a sense of what is in the national pain strategy it might be helpful to us. There are six components to it: people in pain - that is a national priority; knowledgeable, empowered and supported consumers; skilled professionals in state of the art pain care; access to interdisciplinary care at all levels; quality, improvement and evaluation, which is a key component; and research, which is key to all of this area.

I thank members for their questions. Deputy Ó Caoláin asked about a long timespan of pain of more than 20 years. What the patient tries to do is self-manage their pain at first before going back and forth to their general practitioner. Eventually, if it is an orthopaedic problem they get to see the orthopaedic surgeon, but by the time they access a pain service they have developed several causes for their pain and they continue to go back and forth to their GP for different key aspects.

What we are saying, in terms of the model in other areas, is that they have simple analgesics, and then the person can get access to a service. It is a much different process. What is important about the UK - all members asked about this - is how they generated savings. They generated savings of 35% per patient by taking an interdisciplinary approach. That meant that the number of patient visits to the GP was reduced, which was key because, as I said earlier, seven to ten visits a year per person is the norm.

As Ms Cathy Sexton said, we need to span out interdisciplinary care, which starts at primary care level. In terms of the multidisciplinary care, with which I have experience, the GP comes in on that. That is key, because we cannot work without the GPs, who are the first port of call for these patients in pain. I thank the members and I hope that answers that component of it.

I gave members the testimonies which prove that patients are struggling in their pain.

Dr. Keaveny answered Deputy Mitchell O'Connor's question regarding anaesthetists and specialised pain consultants.

I am involved in the Ireland East health care group, which involves the university and 11 hospitals. That will be strategic in this process because, as Dr. Keaveny said, we can have the centres of excellence, but this magnet component is important also. That is key for all our patients.

A key point for me when one is talking about an interdisciplinary approach is ensuring everybody gets to the table and that they all work together. It is difficult because it often means that we need a physiotherapist, an occupational therapist, a pain nurse, a pain consultant and a psychologist. In some cases, it must be remembered that the use of opioid medication will be a key issue. Opioid addiction is at epidemic levels in the United States, which is why we need true interdisciplinary teams. Substance abuse and psychiatry also have to be considered in that regard. That is not to say patients in pain are not entitled to opioid analgesics, but the misuse of such drugs will be a key component. Our patients are surviving all of their treatments.

What is interesting about diabetes is that an enormous amount of funding has been put into dealing with the problem, which is welcome. Diabetes can result in many complications from the head to the toe. However, what is missing from the picture is the fact that the majority of diabetes sufferers develop chronic pain. That is another co-morbidity factor in its own right. I hope I have answered all of the questions posed.