This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.

The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.

One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.

The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?

Opioids and invasive procedures

Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.

Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.

Addressing the contributors to pain

Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:

• education
• advice
• structured exercise programs
• physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.

Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.

The interventions have minimal side effects and are cost-effective.

In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.

In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.

Why isn’t everyone with chronic pain getting this care?

While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.

In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.

Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.

Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.

Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.

So what can we do about it?

We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.

Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.

Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.

Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Polycystic ovary syndrome (PCOS) affects one in eight women globally. However, this complex hormonal condition is under-researched and often misunderstood.

This is partly due to its name, which overemphasises “cysts” and the ovaries. In fact, you can have PCOS without cysts.

It can affect many parts of the body, not just the ovaries, leading to acne, excess body hair, changes in metabolism and even mental health issues.

Our new research, published today, shows that changing the name would help better reflect the complexity of PCOS and improve awareness about this condition. We surveyed 7,700 health professionals and people with PCOS and found the majority supported a name change.

What is PCOS?

PCOS is a chronic condition caused by an imbalance of multiple hormones – the body’s chemical messengers – that circulate through the body.

Genes and environment play a role. Lifestyle factors, such as diet (especially ultraprocessed foods) and activity, can also lead to weight gain and worsen its severity.

In PCOS, the “cysts” are actually partially developed eggs that, due to underlying hormonal imbalance, remain dormant. This means they are less likely to be released (ovulation).

Unlike conventional ovarian cysts, these dormant eggs will generally not grow larger, cause pain, require surgery or burst. Instead, they are slowly reabsorbed over time back into the ovary.

Having dormant eggs in your ovaries is not, by itself, enough to be diagnosed with PCOS – and you can have PCOS without any dormant eggs.

So, what’s needed to diagnose PCOS?

For adults, a diagnosis requires two of three features:

1) irregular periods (due to limited ovulation)

2) high levels of certain hormones (androgens), such as testosterone, which is evident either in blood tests or symptoms (excess facial and body hair, acne, and thinning/balding scalp)

3) excess dormant eggs detected either on an ultrasound or ovarian hormone blood test

In adolescents, only the first two criteria are needed for a diagnosis. Ovary tests (ultrasound or blood tests) are not recommended until after age 20, as changes in the ovaries are common during normal adolescent development.

However, these criteria focus heavily on the ovaries and menstrual cycles, neglecting the condition’s broader impacts.

Widespread health effects

In fact, hormonal imbalances in PCOS affect multiple systems in the body. This can include:

metabolism – higher blood pressure and cholesterol, and greater risk of heart disease and diabetes.

reproductive system – irregular menstrual cycles, reduced fertility and pregnancy complications and increased endometrial cancer risk.

skin – excess facial/body hair, acne, scalp hair thinning and dark skin patches.

mental health – anxiety, depression, disordered eating and body image concerns.

PCOS has also been linked to sleep apnoea (a sleep disorder involving irregular breathing, snoring and fatigue) and inflammatory conditions such as asthma.

Widespread confusion

It’s not uncommon for women with PCOS to see two or three doctors and wait years for a diagnosis. Many types of doctors, including GPs and hormone, skin and fertility specialists, may be involved in care.

Often, health-care providers focus on reproductive concerns, overlooking other health impacts.

Common but problematic approaches include not informing women of the diagnosis, telling them not to “worry” about their PCOS until they wish to conceive, providing inadequate information or only addressing the problem in their speciality area, such as infertility.

This fragmentation creates a troubling paradox. Some are told they’ll face infertility. Yet without proper education they may be unaware they can still occasionally ovulate and may experience unexpected pregnancies.

Conversely, others planning for families often face unforeseen fertility difficulties that early comprehensive care – such as reproductive life planning, healthy lifestyle and early treatment – could have addressed.

The case to change the name

In our new study, we surveyed 3,462 health professionals and 4,246 people with PCOS across six continents.

We wanted to find out what health-care professionals, doctors and those affected by the condition understood about PCOS, and whether understanding has improved over time.

We also wanted to understand whether changing the name – for example, to include “endocrine” or “metabolic” – could have a positive impact, given frequent confusion and misdiagnosis.

Support for a name change was widespread: 86% of women with PCOS and 76% of health professionals said renaming PCOS would better reflect the condition, reduce confusion and likely lead to better outcomes.

We are now leading an international process to find a consensus on a new name and formally change it in the International Classification of Diseases. This involves engaging widely with health professionals and people with PCOS.

By reframing PCOS beyond a purely reproductive disorder, a name change can support broader research funding, education and advocacy. It may lead to better recognition and improved diagnosis, care and outcomes for people with PCOS.

Combating misinformation with evidence

Accurate information is critical for proper PCOS management. Yet misinformation about the condition – for example, that PCOS can be cured through diet or exacerbated by the oral contraceptive pill – is rife on social media.

We have also co-designed and developed evidence-based guidelines and free resources for people with PCOS to find out more about the condition, including the free “Ask PCOS” app.

Renaming PCOS is another key step in improving knowledge about this understudied condition – and care for the 170 million women affected worldwide.

Helena Teede, Director of Monash Centre for Health Research Implementation, Monash University; Chau Thien Tay (Jillian), Research Fellow, Monash Centre for Health Research and Implementation, Monash University, and Lorna Berry, Consumer Lead, Centre for Research Excellence in Women’s Health in Reproductive Life, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.