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Come on, come on, give me something for the pain

Andrew Laming

by Andrew Laming

17 Aug 05:40am

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Filed under: Drugs, Health, Pain, Prescriptions

21 comments

Love can free us from the pain of life, Sophocles argued. But people like Raylee and John would disagree.


John painted houses until his back gave way. Facing $12,000 health bills even on private health insurance, Raylee wrote to me about her husband in despair. No one wants to be dosed up on everything the pharmaceutical the world can offer. John has no choice; the relentless and gnawing neuropathic pain now consumes a third of his Workcover payment.

Nearly one in three Australians live with some form of chronic pain with just 20 per cent of these satisfied with their pain management. Along the spectrum of pain, the worst of the worst is neuropathic pain. It has driven some to suicide, yet there is not a single drug specifically designed to treat this kind of pain funded on the PBS. It’s pain from a limb which is no longer there. It’s the pain after shingles where even a zephyr of wind or the brush of a garment can elicit electric shocks. No pain is nastier than when one’s neurological system turns on itself.

For decades, there has only been narcotic analgesia for these patients. Being narcosed for life isn’t pleasant. But finally there is Lyrica. According to pain experts it is the Holy Grail, a drug which can rescue pain sufferers from the brink and get them off narcotics.

Deemed safe and effective by our TGA, Lyrica’s next stop was with the Pharmaceutical Benefits Advisory Committee (PBAC). As Australia’s drug referee, the PBAC removes the politics by mediating the complex price and access negotiations between drug firms and government.

But at this point, it was our federal government who walked off the field to sulk in the change room. Only ‘life-saving’ drugs will be approved. That condemns people like Raylee and John to a lifetime of finding up to $500 a month for Lyrica.

Leading pain expert Michael Cousins views the rejection of Lyrica as a human rights violation which forces people to live in pain all the while it is available and declared to be safe and cost effective.

Lyrica’s planned cost of $30 million annually is just a fraction of the overall $34.3 billion annual cost to the economy from the effects of chronic pain – a $1133 return per dollar Treasury’s bean-counters could only dream about.

The point where the economic pain of government trumps the neuropathic pain John lives with, depends on your point of view. Unlike his pain, this government’s debt position is entirely self-induced.

Australia led the world with its PBAC, which kept politicians out of new drug approvals. If drug benefit per dollar stacked up, new drugs were approved. That provided certainly to pharmaceutical companies. Make the grade and you will get a return, free of molestation from governments which can’t run their books. Now the government is simply saying, we know better than the health experts do.

The Health Minister calls delays like Lyrica a deferral. But a deferral without an end date is really a rejection. Rejecting drugs for battlers like John didn’t used to be the Labor way. But eventually too many promises, too much free money and too much waste means the party is over for the Green/Labor coalition expert in spending but not saving.

Denying Australia Lyrica, when ever other developed nation provides it for its citizens is totally unjustifiable. Australia was once a nation that pioneered funding treatments that embodied the fair-go for those suffering pain. Despite having the best economy in the OECD, its every other nation that has found a way to afford Lyrica.

Ditching the PBAC process is disappointing. Previous administrations used to take the really big decisions to Cabinet, but even that has been dumped. ‘Need not even apply’ is the sign on the Health Minister’s door for little reason other than they spent too much on pink batts and school halls and now the cupboard is bare.

Denying Australians Lyrica is hitting people in every community around the nation; those with diabetic and cancer-related neuropathy, spinal cord injury, multiple sclerosis, limb amputation and pain following shingles, traumatic neuralgia, or stroke.

None of us would want to see Australians living with avoidable pain, while a treatment is both available and approved. But the Gillard government seems more intent treating its own economic pain than it is serving Australians who are living with the real thing.

Most commented

21 comments

Show oldest | newest first

    • M says:

      06:11am | 17/08/12

      What about medicinal cannabis?

      Reply

    • TChong says:

      07:21am | 17/08/12

      Lyrica ( pregablin ) has been around for a while, usaully pretty effective, but like all drugs, has its side effects.
      Great to hear that the Libs are going to shovel more money towards “health”.
      As Ive often said, and as Andrew Laming publicly confirms and endorses - taxpayers money will solve most health problems.

      Reply

    • Chronic Pain sufferer says:

      08:08am | 17/08/12

      The way I read this, the “[treatment for] avoidable pain… is both available and approved.”  It is still available and approved, just not Government-subsidised.

      Life is expensive sometimes, doesn’t mean the Govt should step in.

      Reply

    • Rose says:

      08:32am | 17/08/12

      The fact is that for every drug approved to go the PBS there are others that miss out, and some of those others are just as important to other people as Lyrica is to this couple.The way this article read was as a bit of a whinge really, low on reasoned argument and high in wah wah factor.
      You want this drug approved, lobby better, be more informative, come up with a coherent and compelling argument and then get the public onside.
      I’m not necessarily disagreeing the the decision sucked, I don’t know, but I do know that you won’t win a lot of support the with the way this is written.

      Reply

    • Kylie says:

      08:33am | 17/08/12

      I too take Lyrica for neuropathic pain as well as fibromyalgia…I pay $360 month for the only drug that has EVER helped this agony…but sadly, I am also on a disability pension - Lyrica is NOT subsidised at all UNLESS: You are a veteran…you have epilepsy or parkinson’s disease OR you go through the pain management specialist at your local public hospital and you buy it through the hospital pharmacy. Unfortunately, the waiting lists for these pain management specialists can be months, even YEARS long. These specialists are also not well educated enough to understand basic cause and effect. After two years of battling with them about how my rare genetic connective tissue disorder (Ehlers-Danlos Syndrome if anyone is interested…) causes daily dislocations, microtears of ligaments, bruising, swelling etc. They told me that after repeated dislocations, they don’t hurt anymore and do not cause inflammation. They simply could not wrap their minds around the fact that dislocations DO hurt, no matter how many times you do them and that I wasn’t hurting because I was ‘depressed’, but that I was depressed because I was hurting!! I could not get them to understand how it felt at 22 to give up a career I loved, independence (I had to have help to bathe, dress etc) and many hobbies because I was in constant agony. Instead, they put it on my file that no one in that clinic is to prescribe me any pain medication - for neuropathic, muscle, joint or any other pain. LUCKILY, my GP had been treating me for 16years and sent me elsewhere as he wanted my pain to be better managed. Unfortunately that means expensive drugs such as Lyrica which could literally help TENS OF THOUSANDS of people suffering…and the government won’t get it put on the PBS :(

      Reply

    • Scotchfinger says:

      10:26am | 17/08/12

      deepest sympathies Kylie. I hope you have good friends to get you through.

    • Kylie says:

      12:14pm | 17/08/12

      Thankyou Scotchfinger. I do have amazing friends and a support network full of people like myself that I created. All of what I mentioned is compounded by the fact I am only 27…one of many of hundred of thousands of disabled people who fall through the cracks in the system

    • Sam says:

      08:38am | 17/08/12

      I do not have any qualifications to know if the Labor government is doing the right thing or not in delaying it from getting on to the PBS schedule. There is always claims some “miracle drug”, should be included, sometimes justifiably but usually not.

      I doubt they would delay it due to other spending, if it is as good as the author paints, it would allow large savings from not needing the other drugs.

      Reply

    • Shane From Melbourne says:

      08:52am | 17/08/12

      Hmm, let’s see, where could we find the money for this pain relieving drug? Abbott’s maternity leave scheme? Nah, middle class welfare is untouchable. Government would rather fund a $65,000 six month holiday than fund “health”

      Reply

    • Scotchfinger says:

      09:10am | 17/08/12

      I dislike writers who name-drop Greek or Latin greats, out of context and in a manner that does not really serve to illustrate their main point. Therefore, I refuse to read this article.

      Reply

    • James1 says:

      09:44am | 17/08/12

      You truly are a man of principle.  One wonders what Zeno would say about the position you have taken…

    • Scotchfinger says:

      10:39am | 17/08/12

      he would chastise me for my poor logic, no doubt, and then scorn my comments on a public opinion-site: ‘what should you care for the opinion of others? It is Zeus only who you should look to…’

    • Bitten says:

      12:24pm | 17/08/12

      Ah, matters of principle.

    • James1 says:

      09:40am | 17/08/12

      “Denying Australia Lyrica, when ever other developed nation provides it for its citizens is totally unjustifiable.”

      I’d like to unpack this a little.  Firstly, I’d be interested to know if this medicine is subsidised in the United States.  Somehow I doubt the US is providing this drug for anyone, what with their user pays system of providing medicines.

      Secondly, this overstates the situation.  My understanding is that the drug is available, it is just not subsidised for poor people.

      Reply

    • AdamC says:

      10:06am | 17/08/12

      @James1, you are correct.

      I also thought this article was quite naive. In my limited experience, expecting any medication to be a ‘Holy Grail’ is unwarranted. Also, it is lttered with almost laughable rhetoric, like the suggesting not funding Lyrica is a ‘human rights violation’. Please.

      Ultimately, It is a shame that the government cannot afford to fund the subsidisation of this drug at this time. However, you cannot, on the one hand, blame Labor for not funding a particular medication and, on the other, complain about their reckless spending.

    • Ted says:

      03:51pm | 18/08/12

      If you’d be to Detroit recently, I think you’d have second thoughts about whether the US is a developed nation.

    • Natalie says:

      09:49am | 17/08/12

      People disabled by pain on disability pension = can not work/earn/pay tax = can not afford unsubsidised pain medications = can not work/earn/pay tax = stay on pension….


      People accessing affordable pain management = can work = stop claiming disability pension = can work/earn/pay tax = contributing to cost of subsidised pain medications

      Not helping people to manage their pain effectively, and therefore people being unable to work and contribute financially to our economy, costs a fortune, much more than subsidising prescription medications.  Even from a capitalist/productivity perspective it makes much more sense to subsidise effective pain management.

      The loss in tax dollars of my not being to work -due to pain- alone (without the pension I claim, the time I spend in hospital, all the doctors I utilise, the cost of the carer’s leave my partner takes) is much more than the cost of subsidising medication.  Its a simple equation.

      Reply

    • Pharmacist says:

      10:42am | 17/08/12

      This is only half the story. There is a much cheaper medicine, which is very similar to Lyrica which has been around for years - gabapentin. It too is only available on the PBS for epilepsy and Parkinson’s, but because it is available as a generic, the manufacturers don’t want to spend the money of going through the PBAC and then applying for PBS listing.
      The government could save itself millions and millions of dollars by listing gabapentin, but they don’t.

      Reply

    • Monica's wicked stepmother says:

      10:54am | 17/08/12

      I doubt any drug is the “Holy Grail” for pain.  Pfizer ha been heavily fined for promoting “off label” uses for their drugs, including Lyrica: http://www.stopmedicarefraud.gov/pfizerfactsheet.html

      This means that there is no controlled trials that prove the efficacy of these drugs for the “off-label” uses.  Surely a “Holy Grail” drug would have had double-blind trials?

      Pain Specialists have a limited arsenal of drugs.  They are particularly vulnerable to drug companies promoting “off-label” uses.  Consider Gabapentin - where 90% of its sales are off-label, usually for chronic pain.

      I am a chronic pain sufferer and am all for effective pain relief.  But drugs need to be declared effective by controlled trials - not anecdotes from medical practitioners.

      Reply

    • TheHuntress says:

      03:47pm | 17/08/12

      As a diagnosed chronic pain sufferer, I would love the opportunity to take Lyrica. Sadly, I can’t due to an odd reativation of a common virus which gave me liver disease and iron overload. My holy grail consists of a combination of narcotics, analgesics, tri-cyclics and benzodiazapines. At least it’s giving me some relief in the meantime.

      But to address the issue at hand here I was “lucky” that my Chronic Regional Pain Syndrome came about due to a work injury and was covered by workers comp. Although I blame the inefficiencies of the workers comp system in the first place for landing me with chronic pain, at least they covered the cost of my drugs. I have since been paid out, have been off work for quite some time, but am at a point now where I can look for a new job. I’m hoping when my liver is all good again (by the end of the year, fingers crossed) I shall be able to start lyrica, as my current combination of drugs is a lot and while the people in my local pharmacy are very, very nice I would rather spend more time with my friends, than my local pharmacist.

      Reply
 
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