The recent Four Corners investigation into endometriosis care is deeply distressing. Allegations that a gynaecologist operated on women without confirmed pathology, leaving them violated physically, financially and emotionally, are shocking. For the women affected, the trauma is immeasurable.
But this is not an isolated story.
It is impossible to watch this investigation without recalling the earlier Four Corners report into spinal cord stimulators, a high-cost, invasive intervention widely classified as low-value care at a population level, and one that has resulted in significant harm for some patients.
Different clinical areas. Different procedures. Different specialists.
Yet the same underlying pattern.
And the common thread is chronic pain.
Let me be clear.
Surgery for endometriosis can be essential, and in many cases life-changing. Spinal cord stimulators have transformed lives for a minority of patients. Interventions absolutely have a place.
But people living with chronic pain should not feel as though they are rolling the dice on whether a procedure will restore their quality of life, or make it worse, because safer, coordinated and evidence-aligned options were not accessible to them.
That is not simply a clinical issue.
It is a systems issue.
The Structural Gap
Chronic pain affects one in five Australians and is the leading cause of disability and lost productivity, in Australia and globally.
Yet at a national level, chronic pain is not recognised as a condition within our core health data systems. It remains largely invisible, buried under diagnostic categories and treated as a secondary symptom.
When something is not captured as a condition in its own right, it is not measured properly. When it is not measured, it is not planned for. And when it is not planned for, it is not funded or governed in a coordinated way.
That invisibility drives fragmentation.
And fragmentation leaves consumers exposed.
The National Levers We Should Be Using
If we are serious about reducing harm and strengthening system integrity, we need structural reform, not just professional regulation after the fact.
Clear national levers include:
1. Formal recognition of chronic pain as a standalone condition in national data systems As recommended in Chronic Pain Australia’s Whitepaper, chronic pain must be consistently coded, captured and reported across jurisdictions so prevalence, outcomes and system performance are visible at the federal level.
2. A coordinated cross-portfolio governance structure within the Department Chronic pain intersects with productivity, mental health, suicide prevention, priority populations, chronic disease, disability, primary care and education. It requires defined leadership, accountability and coordination across these domains, not siloed responsibility.
3. Development of National Standardised Outcome Measures We should be measuring function, participation, quality of life, work retention and safety nationally, not just activity or procedure counts. Without consistent outcome measures, variation and harm remain hidden.
4. Targeted investment in primary care and interdisciplinary models Evidence-based pain management must be accessible early and equitably. Primary care needs infrastructure and support to deliver coordinated biopsychosocial care, not default escalation.
5. Stronger safeguards for high-cost and invasive interventions National registries, mandatory outcome reporting, transparent evidence thresholds and active post-market surveillance should be standard, with information publicly available to consumers.
6. Sustained investment in research and translation We need investment in novel treatments that target pain mechanisms and in implementation science to ensure the solutions we already know improve lives are embedded into routine practice.
A Better Standard for Consumers
People living with chronic pain are often navigating exhaustion, financial strain and desperation for relief. That vulnerability must be met with protection, transparency and evidence-aligned care.
Surgery has a role. Devices have a role. Medications have a role.
But they should exist within a system designed around safety, coordination and long-term outcomes, not one where consumers carry disproportionate risk because structural reform has lagged behind need.
Every investigation reveals individual failures. But taken together, they also reveal a national blind spot.
Chronic pain is Australia’s most significant health and productivity challenge. Until it is properly recognised, measured, funded and governed within a coordinated national framework, variation in care will persist, and consumers will continue to bear the risk.
We can and must build a system where:
· Surgery is offered when appropriate and supported by evidence.
· Devices are used carefully, with transparent outcomes.
· Multidisciplinary care is accessible, not aspirational.
· Consumers are not left feeling like their only option is to roll the dice.
The question is no longer whether chronic pain is a major health issue.
The question is whether we are prepared to treat it like one.
This Op Ed was authored by Chronic Pain Australia Chair, Nicolette Ellis.