Understanding reasonable and necessary supports for effective pain management
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Pain awareness month (September) encourages us to discuss a crucial aspect of pain management in an NDIS context: what are considered ‘Reasonable and Necessary’ supports?
Don’t let the jargon scare you - this is about making sure the right help reaches those dealing with disabling pain, making their lives better in ways that are truly meaningful.
Decoding “Reasonable and Necessary Supports”
Think of the “Reasonable and Necessary” criteria as the rules that guide your services that enhance your quality of life. It’s like having a roadmap that shows how to use your plan to make life more manageable, so you can tackle your pain-related challenges with more support and assistance. It helps to know that pain isn’t just a physical sensation; it impacts your emotions and daily interactions. It’s a whole person experience. As such, NDIS supports should be designed to help you regain control, working towards your goals and an independent future.
Guiding principles for accessing pain-related supports
Accessing these supports isn’t as complex as it may seem. Here’s what the NDIS will consider when they look to approve your requested supports:
Your goals in focus: Supports should align with your approved plan goals.
Enhancing your engagement: They should enable you to participate more actively in your community.
Balancing benefits and costs: Supports should provide good value for their cost.
Effectiveness and benefits: They should genuinely help, based on proven practices. At times, there may be a lack of scientific evidence to support the effectiveness of the support. In these circumstances you’ll need to provide evidence of how they help you. You might achieve this by taking notes on the impact of your pain before your support started and several months after it has been in effect.
Considering your network: The NDIS will emphasise the importance of your family and friends’ contributions. Yet don’t be afraid to tell the NDIS that these informal supports are not viable long-term solutions.
Tailored for you: These supports are here to enrich your life in ways that other services can’t. Specifically, you’ll need to explain why the health care system is not the most appropriate area for you and your conditions.
With that in mind, let’s explore a few pain management supports that someone might request.
Physiotherapy: Generally speaking, physical health interventions implemented by an appropriately qualified AHPRA registered therapist will be considered reasonable and necessary, if there is sufficient evidence that the care cannot be provided by anyone else and that the intervention is likely to be effective.
Medication: There is a specific “operational guideline” that discusses whether the NDIS would fund medications for either curative or preventative reasons. In both cases, they state that clinical treatment is the responsibility of the Health System and not the NDIS, as such, this fails to meet the reasonable and necessary criteria.
Spinal cord stimulation: Similarly with medication, surgical procedures are clinical treatment and is the responsibility of the Health System and not the NDIS, as such, this fails to meet the reasonable and necessary criteria.
Massage: In isolation, massage is almost 100% not a reasonable and necessary support. When discussing capacity building supports, the NDIS pricing guidelines explicitly state, “these support items cannot be used for massage, delivered directly to impact a body part or body system, as these supports are more appropriately funded by the health system.”
Low cost Assistive Technology: Lumbar support cushion (example only) in certain circumstances, these could be justified as reasonable and necessary. You would need a good degree of evidence to support the request, but it isn’t a stretch to see how these could facilitate community access (in the car) or study/work activities (on a desk chair).
Core supports: Disability support workers may be able to help with self-care activities in the home and community to take the load off. They may also be a great resource to help with self-management strategies in the form of reminding, supporting, encouraging and facilitating therapist prescribed activities.
Psychosocial supports: A psychosocial recovery coach may be a great facilitator of self-management strategies when it comes to pacing your way through your daily tasks and activities or even helping connect you to other supports or providers.
National Pain Month shines a light on pain and its many, intricate management strategies, but remember that you’re at the centre of it all. By utilising the criteria for “Reasonable and Necessary” supports, you’re taking a proactive step toward managing your pain and enhancing your life through your NDIS plan.
Some management strategies may be covered by your NDIS plan, and some may not, but together they can form an integrated approach to pain management. Kinora has created a free download to help you visualise your widening circle of support that could be beneficial outside of your plan.
By finding the combination that works for you (in conjunction with your health team), you can overcome the limitations of pain and move towards an empowered future.
Image Description: Simon Ashton, Physiotherapist, is smiling, wearing a navy blue collared shirt and has blonde curly hair and an auburn beard and moustache.
Simon Ashton is a Physiotherapist with a passion for complex pain management and primary contact Physiotherapy in the emergency department.
He’s motivated to deliver high-quality care to everyone, through inclusion, support, guidance and compassion.
Simon is focused on managing patients’ ‘pain experience’ as quickly as possible and teaching them how to self-manage as effectively and sustainably as they can.
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