FOR Newcastle West's Carolyn Ward, 64, federal reforms to private health insurance suggest more pain on the horizon.
Ms Ward says two decades of back and leg pain, related to arthritis, made her rethink "every aspect" of her life, from her to ability work and look after her grandchildren, to taking trips to the beach.
"It eventually got to the point where I couldn't walk very far, couldn't sit for long periods of time, couldn't stand for a long period of time,” she said.
“I just rocked back and forth because the movement would help the pain."
Ms Ward is one of a “very small” percentage of Australians with chronic pain who use a device implanted into the body to manage symptoms.
She says the surgical implantation of an electrical device, called a neurostimulator, was “life changing”.
Ms Ward was able to afford the procedure using her top-level health cover.
Under changes made to private health insurance by the federal government this month, “pain management with a device” is set to become the only form of pain management not covered as a requirement of mid-range hospital policies.
Insurers will be required to cover the devices in top-level, or “gold tier” policies, but will be able to decide whether devices are covered by cheaper “basic”, “bronze” or “silver” polices.
There are lots of patents on these devices but there are very few high-quality trials which show that they are effective.Dr Chris Williams
According to the new rules, all other forms of pain management will be covered by bronze, silver and gold policies. Insurers have until 2020 to apply the changes.
Ms Ward is worried the reforms will jeopardise her ability to claim for maintenance or replacement of her device in years to come.
Her doctor, Newcastle-based pain specialist Dr Marc Russo, who is also the director-at-large of the Neuromodulation Society of Australia and New Zealand, has been campaigning for cover to be expanded to bronze and silver policies.
Pain Australia, the peak body for organisations in the pain sector, has "welcomed" the reforms.
“The vast majority of those with chronic pain will have similar access to pain management services,” Carol Bennet, the chief executive officer of Pain Australia, said.
“It also means it will be clearer and more transparent for those dealing with insurers.”
Ms Bennett said the “next discussion” that needed to be had with insurers was making sure those accessing devices on lower-cost plans continued to be able to do so.
“Those procedures are costly, but not always. They have been known to be available in [the equivalent of] bronze and silver policies.”
Dr Chris Williams, research fellow at the University of Newcastle’s School of Medicine and Public Health, said he supported the placement of devices in the highest level of cover.
“It’s early days for these types of devices,” he said.
“There are lots of patents on these devices but there are very few high-quality trials which show that they are effective.
“There is some evidence, although not very recent, that such devices have a high rate of adverse events.”
Dr Williams, who also leads the musculoskeletal program at Hunter New England Population Health, said government policy should prioritise access to “multi-modal” care for chronic pain.
He referred to interdisciplinary clinics, like the Hunter Integrated Pain Service, which bring together pain specialists, physiotherapists, psychologists and other supports.
“According to the research that’s available, that is what is effective for patients, and it’s cost effective as well.”
Ms Bennett estimated the number of Australians with chronic pain using a device to manage symptoms was “very small”, between two to five per cent.
Data from nib Health Fund showed that 308 of their members had a hospital episode for pain management with a device last year, compared to 1,311 members admitted for pain management without a device.
“It’s a very limited treatment option for people who have tried most other things,” Ms Bennett said.
Ms Ward said that was why she wanted to be sure she could continue accessing services for her device.
“I don’t want to have to go back to what I was experiencing before,” she said.