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Are we offering the best care for patients with musculoskeletal pain?

Musculoskeletal pain conditions are the biggest cause of disability internationally. So what are the problems in healthcare settings?

  1. Imaging is being overused in patients with lower back pain. In fact, 25-42% are being referred for imaging despite it not being routinely recommended. Interestingly, 69% of GPs would refer patients with rotator cuff tendinopathy at first presentation, and 82% of these would refer for ultrasound.

  2. Despite research trials indicating the poor efficacy of opioids for chronic musculoskeletal conditions, and even in outcomes of acute low back pain, many are still being prescribed them despite their addictive properties.

  3. Only 20% of patients with low back pain are given advice and education about their condition.

Clinical practice guidelines have now identified eleven areas in the management of patients with musculoskeletal pain to ensure they receive the care required.

  1. Care should be patient-centred, enabling a shared decision-making process.

  2. Red flags, and suspicions of pathology need to be screened at first contact.

  3. Psychosocial factors should be considered in patient presentations.

  4. Imaging should only be used if pathology is suspected, conservative care has failed or if management will likely change once results have been attained.

  5. A full physical examination should be conducted.

  6. Outcome measures should be used in patient evaluation.

  7. Effective communication and education should be part of patient management.

  8. Patients should be recommended to exercise or engage in physical activity.

  9. Manual therapy should be used in collaboration with exercise therapy, education, and activity advice.

  10. Patients should be encouraged to continue to work or have a plan to return to work.

  11. Patients should be offered conservative treatments before a surgical intervention is considered in non-red flag conditions.

These considerations should be applied to the care of patients with osteoarthritis, neck pain, low back pain, and shoulder pain. If clinicians can consider these eleven recommendations then patients will receive a standardised healthcare plan to help patients make well informed decisions about the care they receive.

Lin, I. et al. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine. 54: 2.

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