Care pathways for people with musculoskeletal pain, and other pain, is evolving. However, the burden of pain is substantial in Australia and globally, including in low, middle and high income countries. Ongoing pain influences peoples’ levels of physical activity, emotional functioning, social engagement, work attendance and performance, family life, income and overall health. This is associated with a burgeoning of healthcare expenditure.

Building workforce capacity to support improved pain care is critical, now and into the future. A growing evidence base underpins a re-orientation of care from a biomedical model towards one that considers the complex interactions between a person’s biological, psychological and social factors. These factors are relevant whether pain is acute, recurrent, or persistent/ chronic. Understanding pain from this contemporary perspective helps to orient clinical pathways towards care that is person-centred and reflects the individual mix of factors that characterise each person’s pain experience.

Physiotherapists with competencies in the field of pain are well positioned to assess, treat and guide recovery; to recognise the risk factors that may suggest unhelpful trajectories into and out of pain; to identify modifiable factors (such as beliefs and behaviours) that can promote recovery; to recognise populations at risk; and to appreciate that pain can affect people right across the lifespan from childhood to old age.

It is recognised that there is substantial physiotherapy expertise in the pain field already in Australia. Increasingly, attention is also being given to people with acute presentations, targeting over-protective attitudes, behaviours and personal stressors, in an attempt to reduce the transition to chronic pain states.

Expert physiotherapists are demonstrating leadership in the pain field in many ways including:

• promoting helpful beliefs and behaviours about pain


• role modelling skilful care that reflects contemporary evidence and is person-centred


• fostering the development of peers in the pain field, enhancing their competencies and building health workforce capacity


• promoting collaboration with specialists of other disciplines in the field of pain to support capacity building in the health workforce


• using their knowledge of enhanced care models and the evidence base to educate their teams, various stakeholders, and those determining health resource allocation, thereby strengthening


• the whole of health to promote high-value pain care and reduce low-value care.

To recognise this advanced level of expertise, the profession will be supporting the specialisation in pain physiotherapy process, through the Australian College of Physiotherapists. This process is seen to be of value across three themes:

Promoting advanced professional development: The specialisation pathway offers professional development for pain management leaders in the clinical setting. The opportunity will hone proficient assessment, promote advanced clinical reasoning and recovery/management skills under the profession’s highest standards.

Capacity building: The clinical specialists will create a network of experts in pain to promote shared experience and encourage peer support. The network will collaborate to promote advances in the profession by aligning physiotherapy care with evidence-based approaches and contemporary models of care. In particular, this network will be accessible to support, mentor and disseminate clinical practice guidance from emerging themes from literature with other clinicians in the pain management field.

Developing and disseminating new and innovative models of care: The leadership group will play an active role in working to affect change in healthcare decision-making and the funding of models of care. The coalescing of expertise will create an advocacy platform specific to the profession but one which engages with policy makers, service delivery providers, clinicians and consumers to ensure a coordinated ‘whole of health’ approach to pain care. There also exists the opportunity to form a coalition with experts in other disciplines, and develop a joint strategy that further informs robust pain management care pathways.

The APA is committed to supporting the development of current and future titled pain physiotherapists into the Australian College of Physiotherapists as specialist physiotherapists. The specialisation process will involve supervision, mentoring and placements, in preparation for College examinations. The Pain group are tabling the framework to the College Council in December and, after consultation, it is hoped the first intake will be in mid-2019, with examinations to be held in May 2020. Limited opportunities are available for this inaugural cohort, as they will have a critical role in supporting subsequent registrants. Those subsequent intakes into the specialisation process will follow the standard two-year process.