Management of Pain in the Urban Settings - Essay Example

Pain Management And Primary Clinics In Rural Area          Introduction       In Australian rural areas, many people experience some sort of pain. Pain is a sensory and emotional experience which might be associated with possible tissue damage (IASP, 2002). There are several causes of pain including arthritis, injury or other factors such as accidents. Pain requires relevant management to reduce trauma and other factors that may be brought about by pain. The objectives of pain management are improving patients understanding of their current situation; improve their physical activity despite pain, providing them with skills to handle pain and to help them stop relying on others in such a case. There is variation in the provision of quality pain care in Australia depending on the area. Pain management in the urban areas is provided easily while in rural areas there are many challenges facing provision of quality pain care.       Statement       Most Australians have pain at least once in their life time. Pain can be acute or chronic depending on the time the pain is experienced. Acute pain is that which is experienced less than three months while chronic pain is that which has been experienced for more than three months (Merskey and Bogduk 1994). Management of pain in especially the acute phase is essential in preventing re occurrence of pain. This also prevents the transition from acute to chronic pain which is relatively harder to manage (Linton, 2002). Back pain or disc disorder is one of the most common types of pain occurrence in Australia. Effective management of back pain can assist in reducing the number of people having disabilities in Australia especially the rural areas.       According to the Pain Management Research Institute (PMRI), about 3 million working Australians experience pain. There are several factors which lead to this situation and may include accidents, injury or other factors. Some disease conditions like arthritis are causes of pain. Pain can also result in the working Australians especially in the rural areas. While working in some settings, straining the body is inevitable and this leads to acute pain for instance the back pains. Quality management of pain is vital for the well being of Australians in preventing transition of pain from acute to chronic conditions. Usually, management of acute pain is relatively easier than management of chronic pain.       Management of pain in the urban settings is usually very fast and effective. On the other hand management of pain in the rural and remote areas of Australia is difficult. There are many challenges to accessibility of clinics and physicians in these areas. Clinics are few and are not well equipped compared to those in the urban centers. More to that, many physicians and medical practitioners are based in the urban areas making accessibility of multidisciplinary management difficult.       The number of people with pain in Australia especially the rural areas is alarming. Rural people are involved in activities in which they are more prone to injuries and accidents for instance farming. Using farm machines and equipment can be risky at times causing serious injuries at times. Almost 70% of farmers in Australia have had injuries from the use of the farm machines and equipments. Some farmers can strain while lifting some of the farm appliances or products. By this they end up straining their backs which leads to back pains. In the farming industry, there is no regulation on the amount of work one should perform on daily basis. It is hard to regulate how farmers can work because they own these farms and manage them personally. Lack of regulation of the farmer’s work load has been associated with occurrence of situations which lead to pain (NRHA, 1998). Management of pain in the rural areas is relatively challenging as most farmers are not aware of the self management strategies. If some of them know these strategies, they are poor in carrying them out there by ending up doing nothing at all. The other challenging factor is the accessibility of quality care timely in case there is an occurrence of this condition. Some farmers have their farms very far away from rural towns. In case there is a danger or an emergency, it would be so hard to manage or access the necessary care because of the distance variation.       Back and shoulder pains are some of the prevalent pains in Australian. This form of occupation hazard affects those people who are involved in difficult activities which involve lifting of materials. Farmers and other people found in the rural areas are found to have these pains from time to time as they are involved in some difficult activities. In recent reports, about 8 in every 10 Australians experience back and shoulder pains (Guy, 2009).  About 20% of the Australia people self reported that they had back pains. In the same period about 19% of women had reported having back and shoulder pain while about 21% of men had self reported. This translated to about 3.9 million people having disc disorders in Australia (NHS and AH, 2004).       About 1.94 million were men while about 1.96 were women who self reported having disc disorder. In this study by the National Health Survey (NHS) and Australia Health (AH) clearly showed that women were more prevalent to these pains though with only a small margin. Shoulder and back pains have a lot of effect on the person’s daily chores. Some people are unable to work as a result of these pains. Shoulder and back pains are caused by straining the body by lifting heavy items, bad sleeping positions, being overweight, working in front of a computer for long hours and aging.       Many people are injured in Australia as a result of accidents. In a study carried out by Australia Bureau of Statistics, there was about 20% of the total Australian population injured. It was noticed that the young under the age of 14 years were more prevalent to injury and this proportion decreased with increase in age. Male were found to be involved in accidents more than the women but as the age increased, the proportion of women who suffered injuries increased (ABS, 2006). In this study also, it was determined that most of the people with these injuries were young people. Young people have averted to substance abuse and other drugs.       Drug abuse makes the young people to be more susceptible to accidents and injuries. According to ABS most young people got injuries from road accidents. The main reason was that they drove under the influence of alcohol. Most of these accidents are reported in the rural areas where the roads do not have much traffic. Young people in the major urban centers have knowledge on the possible effects of alcohols while driving. There are many awareness programs which are organized in the urban centers where the young people in these locations get knowledge on this. In rural areas however, there are less or no awareness programs organized. They therefore take some of this stuff for instance alcohol without knowing the possible dangers. The rate of traffic accidents in the rural areas and remote regions of Australia were about 105% and 250% respectively. According to statistics released in 1992 on accidents in Australian highways indicated that more than 50% of these accidents happened in the rural areas. Only about 14% of the total number of accidents was reported to occur in the urban areas. This is largely because of the fact that many young people in these regions have turned to alcohol drinking and substance abuse. The usually drive under the influence of these drugs and they are rarely aware of what they are doing while driving. These substances greatly reduce the response rate of the young people. They are therefore unable to avert an incoming danger as they are unable to act as fast as they are supposed to.       A telephone study was carried out by Strauss to determine the prevalence of pain in Australia. The factors considered were the prevalence of pain in households, the individuals and the age. This survey showed that one out every five people in Australia had pain, one in every three households and the pain prevalence increased with age. Females more than thirty years old were more prone to pain than their male counterparts. The major pain problem was the back pain and the cause was not known. Also, most people had recurrence pain for a period of about three years. The number of individuals who had severe pain was about 45% and those with mild conditions about 55% (Strauss, 1986).       In the community, it was found that about 35% of the households had at least one person with pain. This condition was experienced daily for a period of two weeks or for a period of even three years depending on whether intervention was carried out on time. 31% of the households were found to have a person who experienced pain condition in the previous two weeks. Of the total individuals involved or who participated in this survey, about 19% were found to have experienced pain conditions in their lives. 16% of the individuals were found to have experienced this condition in the previous two weeks before the study was carried out (Strauss, 1986).       If acute pain was not managed accordingly, there was a high probability of transition to the chronic pain. Chronic pain is defined as that which is felt every day for a period of more than three months (Blyth, 2001). In another study to determine the prevalence of chronic pain; it was found that the prevalence in men was 17% compared to about 20% in women. This increased to about 27% in male and 31% in female in the age bracket 65 to 69 years of age. Chronic pain prevalence was associated with increase in age, female gender, lack of health insurance, having poor pain self management skills and low levels of education. (Pain management and research center, 2001).       This study also determined whether there was interference with the daily activities. Pain usually causes psychological distress making these individuals to be unable to go about their daily activities effectively. About 11% of men in this pilot study reported to have some degree of interference with their daily chores. The number of females who reported the same case was about 13%. Young people in the age group 20 to 24 years old were reported to have the highest interference rates with about 84% of female and about 76% of the male reporting this.   Another survey was carried out in nursing homes in Australia and other nations. The prevalence of pain in the nursing was found to be between 27 and 83%. In this survey, it was determined that the aged care centers reported persistent pain in approximately 15% of the nursing population. This symbolized that the elderly were more prevalent to pain than the younger generations. In Australia, about 86% of the people in nursing homes were found to have chronic pain conditions (Madjar and Higgins, 1999). The parts that people complained having pain were the limbs, joints and the back. There was no correlation between the intensity of pain and the age and the time of stay at the nursing homes. Treatment in the nursing homes was given in different form depending on the severity of pain. About 54% of these people were given analgesic treatment which was basically paracetamol. A further 27% were physically treated for instance through massage, use of heat or by slight physical movement. This survey also showed some neglect by the government and other stake holders in pain management in the rural areas. Of the total individuals involved in this survey, 22% claimed that they did not get any analgesic medication when they reported. Instead, they were given other forms of medication like opioids, non steroidal anti inflammatory drugs and anti depressant drugs. In fact, about 31% in this survey reported that they were given opioids, 12% were given non steroidal anti inflammatory drugs and about 54% reported that they were given the anti depressant drugs. Pain management in Australia is a challenging task in especially the rural areas. In these areas, there are few clinics which are not equipped or they are not equipped well. Accessibility of clinics by the people in remote areas is not easy especially at night. Most medical practitioners are based in big cities. There are usually few medical practitioners in these remote regions and therefore they can not be able to handle the number of people who need medical attention. Some people who might be injured and in a lot of pain may end up dying on their way to hospital. Unlike in the urban areas where hospitals or clinics are found in practically every neighborhood, there are few clinics which might be located far away. The above factors sparked the need by the government and other stake holders to intervene in making accessibility of health care needs easier for the people in remote regions. The Australian Human Rights Commission has played a pivotal role in the improvement of some health clinics in the remote areas. Their main aim was to identify and address these people’s needs accordingly with easy and relatively low cost. They also developed health facilities that were well equipped to ensure that they were capable of meeting the demand. There is a lot of commodification taking place and there was need to develop these facilities in such a way that they would be able to cope with any forms of change. These facilities needed some people to volunteer to work in assisting to meet the demands (Australian Human Rights Commission, 2009). Some examples of the health care facilities that have been improved courtesy of the AHRC include Community Health Adolescent Murraylands Peer Support (CHAMPS) (South Australia) ,Coming Home - a workshop on Rural Careers in Health for Year 10 students (New South Wales), Desert Acrobats (Western Australia), Nyirrpi Grandmothers' Women's Health Program (Northern Territory), Sage Hill Carers' Service (Victoria) and Yeoval Multi-Purpose Health Centre (New South Wales). These facilities are in a better position to meet at least 70% of the demand in these areas without a strain. There are many proposals by the government to reform the health care system. This would facilitate the provision of quality care services to all those people in dire need of medical attention especially in the rural areas. The proposal to use airplanes or aero medicine in emergency cases was embraced with two arms not only by the Australian people but also in most nations world wide. This could benefit the people in the remote regions a lot as they would access medical facilities much faster than the past. This would translate to early intervention in the case of injury or acute pain and therefore the rates of mortality would definitely be lower. Support to the organizations and volunteer work societies like the pre hospital volunteer model can be of significant help in accessing the relevant health care. This model was devised by some of the Australian communities with the sole aim of ensuring that the people in the remote regions access quality care. This model has a strong culture with the involvement of medical practitioners, emergency workers and the community volunteer. This model is usually brought together by myths, past stories and formal procedures (O’Meara, 2003). There has been the challenge of ensuring that there are enough self motivated, committed and disciplined volunteers for the provision of quality care to the people in these remote regions. There is also dire need to train and maintain staff and volunteer workers trained for this purpose. This can only be ensured through good management and excellent local governance. Good training, recognition and provision of the necessary resources by an organization can also play role in the delivery of these services to the rural people. Motivating and providing assistance to volunteers will also have an effect in the deliver of service. This model shows how a self reliant community in Australia can take over or control the ambulance activities. For this model to work effectively, all the stake holders involved have to play their roles actively. If not, the model would operate in deplorable conditions in which the goals of providing quality care to the rural people would not be achieved. Good coordination among the nurses, emergency service workers, the local government, local hospital and other medical practitioners has to be practiced for the achievement of these goals. This can only be facilitated by good communication strategies among these key stake holders. Some of the limiting factors for this model are for instance inability to train the volunteer staff effectively. Most of them are not well trained in the medical field and might end up compromising a patient’s health condition.    Conclusion Pain occurrence is inevitable for all persons whether living in Australia or in any other nation. Pain management is important in the well being of Australians. Management of pain depends on the severity and the time of exposure to this condition. Acute and chronic pains can be treated in a number of ways including giving medicine and through other physical means such as massage. Good emergency services should be improved or made available in the areas where there is great need to do so for instance the remote regions of Australia. Proposals and action plans for provision of quality pain management strategies should be implemented and the necessary resources provided for the sustainability of this good practice.     References Linton, S. 2002. New avenues for the prevention of chronic musculoskeletal pain and disability. 2nd edition. Elsevier Health Sciences. Guy, M. 2009. Back and shoulder pains prevalent in Australia. Retrieved on 7th August 2009 from, http://naturalpaintreatment.com/tag/australia/ Australia Bureau of Statistics. 2006. Year Book, Australia. Australian Human Rights Commission (2009), Rural Health. Retrieved on 6th September 2009 from, http://www.hreoc.gov.au/HUMAN_RIGHTS/rural_health/index.html Strauss, S. 1986. The prevalence of pain Complaints in a General Population:  An Australian Study. Meara, P. 2003. The prehospital community volunteer model has a place in rural Australia. Retrieved on 6th September 2009 from, http://www.jephc.com/uploads/990008.pdf Pain management and research center. 2001. Chronic pain in Australia: a prevalence study. Mclean, W & Higginbotham, M (2002), Prevalence of pain among nursing home residents in rural New South Wales, viewed 16August 2009, http://www.mja.com.au/public/issues/177_01_010702/mcc10633_fm.html National Rural Health Alliance (1998), Drugs and Alcohol in Rural Australia, viewed 14 August 2009, http://nrha.ruralhealth.org.au/cms/uploads/publications/rhip4.pdf O’Meara, P. and Journal of Emergency Primary Health Care (JEPHC). The prehospital community-volunteer model has a place in Rural Australia. Read More