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The Spinoff
4 days ago
- Health
- The Spinoff
The Spinoff Essay: A bit of pain
'I'm lucky; I've had it for only five years or so.' David Hill on living with chronic pain. The Spinoff Essay showcases the best essayists in Aotearoa, on topics big and small. Made possible by the generous support of our members. I ache. I'm sore, nearly all the time. I'm one of the estimated 900,000 New Zealanders who suffer from chronic pain. Chronic or neuropathic pain is usually defined as pain that's lasted for more than three months. I'm lucky; I've had it for only five years or so. Multiple thousands of Kiwis have suffered for decades, or their entire life. More statistics. Over 40% of people in the UK are thought to suffer, at various times and to various degrees. (The US estimates almost 50%.) For over-75s in Britain, the figure lifts to 65%. About 80% of this is back and neck pain. In Aotearoa, a 2018 report from research group Sapere suggested that chronic pain costs our health system some $2 billion annually, plus another $15 billion in lost production and benefit costs. Utterly predictably (think housing, working conditions, $60 for a GP visit, $75 for a physio session), it affects lower socio-economic groups more. Oh, and (think trad Kiwi male stereotypes this time), women are more likely to report it than men. In my case, it's cervical spondylosis with foraminal narrowing and radiculopathy. I like to roll out the phrase so I can watch listeners' eyes cross as they wonder how much time I've got left. English translation: my neck is stuffed. Age, plus bad posture at the keyboard, means the cushioning discs between cervical vertebrae have worn thin. Bone spurs have formed. My mobility is limited; I get deep pain in the neck and between shoulder blades, plus intermittent giddiness. I've gone into detail because, like most sufferers – and I dislike that word – I usually don't say much about it. People with chronic pain get little sympathy. Who wants to hear about an ailment that goes on and on, especially when it usually comes with no bandages, slings, plaster, other visible signs of affliction? Like Chronic Fatigue Syndrome and Long Covid, it's easily seen, even by some health professionals, as self-pitying, even malingering. ' Whatever happened to 'pull yourself together'?' I heard one sceptic sniff, after an acquaintance had vented over his months of continuing hip and leg discomfort. It's the least telegenic of ailments; if we do appear on screen, we're usually caricatured as boring old whingers who need to snap out of it. ' It's all in your head,' is another common dismissal. True. Also stupid. Of course it's in the head, because that's where the brain's pain receptors are. We don't register any injury or discomfort till those receptors fire. Trouble is, if the pain continues for more than a few hours, your pre-frontal cortex starts assessing the sensation in terms of what it may mean long-term, and begins reinforcing the synapses associated with stress and discomfort. The brain's 'pain switch' gets stuck in the ON position, and your body becomes convinced of its distress. Neurologist William Davies notes that 'pain carves a path directly between the realms of mind and body'. It's called Control Sensitisation: just as Pavlov's dogs slobbered when a bell rang, almost any tug or tension for a chronic pain sufferer sends those brain receptors into power drive. It means that pain can become a habit, and like many unpleasant habits, it's hard to get rid of. A cycle of discomfort – sleep deprivation – stress – more discomfort and more stress can become established. Withdrawal and depression may follow, with the symbolic Black Dog liable to squat and crap on any of your days. So yes, it is all in the head, and it's utterly genuine. There have been some curious associated discoveries. Women's limbic system responds to pain more than men's, so women often experience greater emotional distress, while the fact that men's pre-frontal cortex is more affected means they may see the issue primarily as a problem to be analysed. And chronic pain may be exacerbated by apparently unassociated events; Brexit, the Covid pandemic, even the Trump presidency saw a rise in reported cases. You're right: the Orange Roughy can indeed become a pain in the arse. Bad news for the next few years. Chronic pain victims make unrewarding patients, even to sympathetic doctors – and not all are. Symptoms are frequently vague and diverse. We're the unwell who can sometimes seem well. Our GPs ask questions, refer us to specialists who ask more questions, at $2 per syllable, rule out nastier possibilities if you're lucky (and that is indeed a help), and usually intone variations on the theme of 'y ou'll have to live with it'. I sympathise with them, actually: as with Chronic Fatigue or Long Covid, we seldom give them the satisfaction of finding a specific cause. So chronic pain is a formless and often unresponsive condition. It can take a long time to get a diagnosis, and it seldom comes with any clear path of action. It can be treated, but seldom cured – whatever that last word may mean. What are the treatments? Painkillers, anti-inflammatories of course, though all of them, except perhaps paracetamol, come with potential side effects. A TROUP (Trends and Risks of Opioid Use for Pain) study in the US found that 22-26% of people prescribed opioids for non-malignant chronic pain ended up misusing their drugs. Distraction, meditation, exercise, diet, therapy, physio and chiropractic, the analytical and shared talk of Cognitive Behavioural Therapy are other courses of action – and action is an early step to taking some degree of control. The New Zealand Pain Society (you'll find them online) offers sensible, practical programmes and resources. Complex Chronic Illness Support, also online, can help as well. Our local hospital used to run chronic pain workshops, where physio, dietitian, psychiatrist, counsellor would reassure attendees that they weren't malingerers; it was a genuine ailment, and here was a list of things that might help. They're the only workshops I've ever attended where some participants stood up every 10 minutes and lay down in the aisle for a bit. They were enormously valuable for their collegial quality, finding that you weren't the only sufferer. They've been discontinued – more funding cuts at Whatu Ora, I gather. Alan Gordon in his book The Way Out estimated that in 2021, there were 1.2 billion chronic pain sufferers worldwide. The number is rising: we're living longer and hurting for longer periods. Other contributing factors include people expecting to be pain-lite and becoming more inclined to seek help when we're not, plus our living in an increasingly isolated society, where loneliness aggravates almost any condition. The outlook isn't great. The future, for me at any rate? Keep learning – in the most positive sense of the verb – to live with it. Take unexpected solace from the fact that on good days, the world can seem brighter and more rewarding than it did before my neck started to pack up. And wonder if assault with the nearest deadly weapon might be a pretty reasonable response to anyone who tells me that it's all in my head.
The Age
03-06-2025
- Automotive
- The Age
Victoria's first petrol price app could increase prices, but still worthwhile: report
An app displaying real-time fuel prices at Victorian petrol stations will cost about $2.4 million a year to run and may only save customers $5 or $10 a year – and could contribute to price increases – but will still be worthwhile, research has found. The Allan government wants to publish up-to-date fuel prices on the Service Victoria app to save drivers time in finding the cheapest petrol. The scheme would cost the government $1.3 million and the industry $1.15 million per year to run, totalling an annual $2.4 million. Consultants asked by the government to assess the plan say it's unclear whether it would decrease costs for consumers — or increase them. Some fuel price transparency schemes lead to cheaper prices, while others lead to higher prices, advisory firm Sapere said. But Sapere concluded that real-time price disclosure would still be worthwhile by saving motorists time. 'On balance, we expect that in the medium to long-term there will be net benefits,' it said in its recent regulatory impact statement. Victoria is the only state or territory without a fuel price transparency scheme. The Australian Competition and Consumer Commission, which monitors the retail price of unleaded petrol, diesel and LPG, found Melburnians could have saved $333 by comparing petrol prices in 2023. Unleaded prices currently range from as low as $1.49 a litre to as high as $2.09 a litre. It takes about 6½ weeks for Melbourne's petrol prices to move from a low point to a peak and back to a low point.
Sydney Morning Herald
03-06-2025
- Automotive
- Sydney Morning Herald
Victoria's first petrol price app could increase prices, but still worthwhile: report
An app displaying real-time fuel prices at Victorian petrol stations will cost about $2.4 million a year to run and may only save customers $5 or $10 a year – and could contribute to price increases – but will still be worthwhile, research has found. The Allan government wants to publish up-to-date fuel prices on the Service Victoria app to save drivers time in finding the cheapest petrol. The scheme would cost the government $1.3 million and the industry $1.15 million per year to run, totalling an annual $2.4 million. Consultants asked by the government to assess the plan say it's unclear whether it would decrease costs for consumers — or increase them. Some fuel price transparency schemes lead to cheaper prices, while others lead to higher prices, advisory firm Sapere said. But Sapere concluded that real-time price disclosure would still be worthwhile by saving motorists time. 'On balance, we expect that in the medium to long-term there will be net benefits,' it said in its recent regulatory impact statement. Victoria is the only state or territory without a fuel price transparency scheme. The Australian Competition and Consumer Commission, which monitors the retail price of unleaded petrol, diesel and LPG, found Melburnians could have saved $333 by comparing petrol prices in 2023. Unleaded prices currently range from as low as $1.49 a litre to as high as $2.09 a litre. It takes about 6½ weeks for Melbourne's petrol prices to move from a low point to a peak and back to a low point.
Otago Daily Times
02-06-2025
- General
- Otago Daily Times
ORC's pest plan ‘partially effective'
Eradicating wallabies from the region is proving a challenge for the Otago Regional Council as credible sightings are increasing. Of the three pest species the council aims to eradicate from the region, the marsupials appear to be giving the council the most trouble, a new report suggests. PHOTO: SUPPLIED The Otago Regional Council is effective at raising awareness of the threats wallabies pose to the region, less so at actually dealing with the pest, a new report says. The mid-term review of the council's 2019-29 Otago regional pest management plan, by consultants Sapere, found the council was "partially effective" in achieving the objectives of its plan to exclude, eradicate, contain or control the 51 pest species it addresses. The council was graded as "effective" at excluding, or keeping out, six pest species identified in the plan — African feather grass, Chilean needle grass, egeria, false tamarisk, hornwort and moth plant. It was also effective at eradicating both rooks and spiny broom. The consultants found the council was effective in raising awareness of the wallaby issue in Otago but "not effective" in reducing populations and preventing spread. But there was hope, the review report said. In particular, the consultants were impressed with the council's work on its "Judas wallaby trials" where helicopter-based hunters follow GPS-collared wallabies to find other wallabies, which are destroyed. "Targeted monitoring by ORC has demonstrated effective outcomes, especially in controlling rooks, spartina, and spiny broom," the report said. "In wilding pine management, ORC has achieved partial effectiveness by leveraging national funding support. "While ORC's wallaby population control efforts are not effective at present, their collaboration with the national wallaby programme has yielded promising results. "Initiatives such as the Judas wallaby trials have contributed to developing targeted and cost-effective control measures." The report said containing wallabies, which could move up to 9km a day, was a challenge because there were limited numbers of the animals across a very large area. It said council staff told the reviewers the at present 1.5 fulltime staff positions would need to increase to five fulltime staff to meet the objectives of the pest plan. "A recent report identified that current funding is indeed too little to maintain gains and progressively eradicate wallabies in Otago, stating that $1.4 million is needed." The reviewers said the plan provided a "framework" for the council to identify priority pest species, set objectives for their control, and outline responsibilities for landowners, local authorities, and other stakeholders. Funding increased from $1.3 million in 2019-20 to $2m in 2021-22. It then jumped to $3.2m in 2021-22, then $3.8m (2022-23) and $4m (2023-24). "The increased funding reflects the fact that the 2019 [plan] introduced significant changes to align with national policies and address local pest management challenges more effectively." The review found overall, the council had made important investments, such as improving pest data capture and increasing its biosecurity team, in response to meeting the the pest management plan's objectives. The changes it had made were "significant", and the council could build on its progress in the first five years and achieve "greater effectiveness" by the conclusion of the 10-year plan. The report suggested "ineffective enforcement" was plaguing rabbit control efforts. Wilding pine containment suffered from inadequate "good neighbour" rules. It contained 13 recommendations to improve the 2019-29 plan and nine recommendations to help prepare the next 10-year pest plan.
Scoop
18-05-2025
- Health
- Scoop
Have You Heard Of Capitation? This One Weird Word Is Why You Can't Get A GP Appointment
Well, it's one of the main reasons. On Friday, NBR's Tim Hunter wrote an article, A window on the world of general practice (paywalled), outlining some realities of the GP industry. And it is an industry – almost all family health clinics in Aotearoa New Zealand are not part of the public healthcare system. They are privately owned, or run by a corporate group. 'Anecdotally, GPs are underpaid, overworked, stressed out and thinking of moving to Australia,' Hunter writes. He also quotes the Government's 2022 Sapere report saying practices probably earn less than the cost of delivering care. 'We know this is true,' says General Practitioners Aotearoa (GPA) chair Dr Buzz Burrell. 'Clinics struggle to recruit GPs, or pay them well enough to keep them.' Many GPA members who work at corporate-owned practices (and even some privately-owned practices) report they are working in awful conditions, and forced to deliver substandard healthcare so the practice can break even. 'If you feel like you are cut short, or your GP doesn't follow up appropriately, it's because of the funding model,' Burrell says. The fee you pay to visit your GP only covers part of the cost of running a clinic and employing the doctor. Hunter's article is a case study on Green Cross, a publicly listed corporate group buying up practices. 'Clearly, running general practices is profitable for Green Cross,' Hunter writes. How are they making it work? Hunter's analysis shows Green Cross medical centres reduced the number of doctors employed, and increased the number of patients per doctor between 2020 and 2024. GPA members report the same thing: to make ends meet, practices are pushing up patient numbers and reducing doctors. This means if you want to see a GP, you're going to have to wait longer, or take a nurse appointment instead. Hunter also talks about capitation, something that GPA is campaigning to change. Capitation is a funding system where the government pays a practice a certain amount of money per person enrolled. This system does not take into account the quality of care delivered, how many doctors are available, or even whether those enrolled patients can get an appointment. 'As you can imagine, this leads to very perverse situations,' Burrell says. 'There are lots of practices simply just taking the piss out of the funding system and exploiting a loophole for profit. 'They've got massive patient lists and one or two doctors supported by overworked nurses, and patients then need to rely on emergency departments and overpriced urgent care facilities when they can't get an appointment. 'Meanwhile, the clinics that are trying their best to deliver quality, timely healthcare are losing money hand over fist.' In Hunter's article, Green Cross responds by saying changes should be made so more capitation funding goes directly to clinics instead of getting tied up in administration costs. GPA's stance is that the capitation model is not fit for purpose. 'Sure, increasing capitation funding is better than nothing,' Burrell says. 'If clinics can get more money they can theoretically hire more doctors and make more appointments available. But the perverse incentives will still be there.' The best thing for patients, he says, would be a 'nice, simple system where GPs are paid for the real healthcare they deliver'. About General Practitioners Aotearoa General Practitioners Aotearoa (GPA) is the only independent organisation exclusively representing the voices of doctors working in general practice. We represent GPs who are clinic owners, employees, contractors and trainees. We are member-funded and receive no government money. GPA formed after the demise of the New Zealand Medical Association to independently advocate for GPs.
