The Inpatient Pain Network
The network connects clinicians and departments across New Zealand to discuss issues and share information on inpatient acute pain care. The group held its inaugural event in late 2019 which had excellent attendance and highlighted the need for this network in New Zealand.
Aims of IPN
The Inpatient Pain Network aims to:
- address the challenges facing inpatient pain services (IPS) in New Zealand, including an increasingly complex patient population, a low resource health environment with limited access to pain psychology, poor access to novel pharmaceuticals, constraints on IPS staffing, and a fairly insular DHB system that reduces opportunities for formal collaboration.
- provide NZ solutions to NZ problems by strengthening communication and collaboration.
- improve inpatient pain services throughout the country.
Annual Report from NZSA Inpatient Pain Network 2019
Established post the Counties Manukau hosted ASM in 2018. Main aim of the network is similar to the other NZSA networks – “The networks provide New Zealand solutions to New Zealand problems.”
There are some NZ specific issues in dealing with inpatient pain problems – a low resource health environment with limited access to pain psychology, psychiatry and drug rehabilitation/CADs services, poor/delayed access to novel pharmaceuticals, an increasingly complex patient population, production pressure from theatre managers to reduce IPS staffing and a fairly insular DHB health system reducing formal collaboration.
On top of the routine post-operative rounding, the inpatient side of pain management includes:
- Peri-operative medical outreach to complex patients after operations,
- The management of vulnerable frequently admitted patients with pain problems,
- Hospital based opioid stewardship and the oversight of pain therapies in the transition from hospital to community
- Management of acute severe pain problems like CRPS, phantom limb pain, acute neuropathic pain in the initial inpatient phase.
- Procedural sedation for painful interventions such as burns dressings.
As of the 23/4/2020 the network has established representation in each of the 20 DHBs.
To date the network has:
- Provided a forum to sort out problems with advanced pain management e.g. sourcing materials for intrathecal catheters
- Ran a national network meeting at Jetpark Auckland with 70 attendees. This meeting involved pain practitioners from medical, nursing and pharmacy backgrounds
- Lobbied PHARMAC (unsuccessfully) for the general funding of buprenorphine transdermal patches
- Started to build a framework to support isolated pain practitioner working at smaller DHB sites
The COVID 19 pandemic has interrupted planning for the 2020 academic year.
The IPS network meeting had provided three options for speakers at the now cancelled Wellington ASA/NZSA 2020 Combined Scientific Congress.
It is the group's intention to run another network meeting in late 2020; at this point we have delayed starting the meeting planning due to the current uncertainty around travel restrictions.
One of the speakers at the 2019 network meeting gave the group a better insight into the PHARMAC requirements for funding new medicines.
The group had made the initial application for buprenorphine patches on a harm minimisation basis. Dr Barnard pointed out that cost utility is the main driver for PHARMAC. It is the groups hope that we can reposition buprenorphine and potentially tapentadol into a new class of atypical analgesics and have their unique pharmacological properties considered without the stain of conventional full opioid agonist clouding the decision making.
Current Chairperson is Mike Foss (Waikato) and the deputy is Rachel Sara (Counties Manukau). We are intending to transition out of the pilot phase of this network and have a formal election/AGMprocess for selecting a new executive for the network in 2020/21.