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.

It’s Saturday afternoon and the kids are all connected to separate devices. So are the parents. Sounds familiar?

Many families want to set ground rules to help them reduce their screen time – and have time to connect with each other, without devices.

But it can be difficult to know where to start and how to make a plan that suits your family.

First, look at your own screen time

Before telling children to “hop off the tech”, it’s important parents understand how much they are using screens themselves.

Globally, the average person spends an average of six hours and 58 minutes on screens each day. This has increased by 13%, or 49 minutes, since 2013.

Parents who report high screen time use tend to see this filtering down to the children in their family too. Two-thirds of primary school-aged children in Australia have their own mobile screen-based device.

Australia’s screen time guidelines recommended children aged five to 17 years have no more than two hours of sedentary screen time (excluding homework) each day. For those aged two to five years, it’s no more than one hour a day. And the guidelines recommend no screen time at all for children under two.

Yet the majority of children, across age groups, exceed these maximums. A new Australian study released this week found the average three-year-old is exposed to two hours and 52 minutes of screen time a day.

Some screen time is OK, too much increases risks

Technology has profoundly impacted children’s lives, offering both opportunities and challenges.

On one hand, it provides access to educational resources, can develop creativity, facilitates communication with peers and family members, and allows students to seek out new information.

On the other hand, excessive screen use can result in too much time being sedentary, delays in developmental milestones, disrupted sleep and daytime drowsiness.

Too much screen time can affect social skills, as it replaces time spent in face-to-face social interactions. This is where children learn verbal and non-verbal communication, develop empathy, learn patience and how to take turns.

Many families also worry about how to maintain a positive relationship with their children when so much of their time is spent glued to screens.

What about when we’re all on devices?

When families are all using devices simultaneously, it results in less face-to-face interactions, reducing communication and resulting in a shift in family dynamics.

The increased use of wireless technology enables families to easily tune out from each other by putting in earphones, reducing the opportunity for conversation. Family members wearing earphones during shared activities or meals creates a physical barrier and encourages people to retreat into their own digital worlds.

Wearing earphones for long periods may also reduce connection to, and closeness with, family members. Research from video gaming, for instance, found excessing gaming increases feelings of isolation, loneliness and the displacement of real-world social interactions, alongside weakened relationships with peers and family members.

How can I set screen time limits?

Start by sitting down as a family and discussing what limits you all feel would be appropriate when using TVs, phones and gaming – and when is an appropriate time to use them.

Have set rules around family time – for example, no devices at the dinner table – so you can connect through face-to-face interactions.

Consider locking your phone or devices away at certain periods throughout the week, such as after 9pm (or within an hour of bedtime for younger children) and seek out opportunities to balance your days with physical activities, such kicking a footy at the park or going on a family bush walk.

Parents can model healthy behaviour by regulating and setting limits on their own screen time. This might mean limiting your social media scrolling to 15 or 30 minutes a day and keeping your phone in the next room when you’re not using it.

When establishing appropriate boundaries and ensuring children’s safety, it is crucial for parents and guardians to engage in open communication about technology use. This includes teaching critical thinking skills to navigate online content safely and employing parental control tools and privacy settings.

Parents can foster a supportive and trusting relationship with children from an early age so children feel comfortable discussing their online experiences and sharing their fears or concerns.

For resources to help you develop your own family’s screen time plan, visit the Raising Children Network.

Elise Waghorn, Lecturer, School of Education, RMIT University

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