Aches and pains in primary care: stay positive but critical

Abstract

The normal state of humankind is to experience some pain some of the time. The dominant causes of chronic pain globally are musculoskeletal conditions such as back pain and osteoarthritis. They tend not to kill people, and mild forms are regarded as an inevitable part of life. GPs, some would say, should concern themselves with the assessment and investigation of pain as a pointer to serious diseases such as cancer or coronary atheroma. Yet the very frequency of aches and pains also signals their importance. Chronic musculoskeletal pain restricts physical activity and participation in social and domestic life. And so common are musculoskeletal conditions that they dominate disability in developed countries and many developing countries as well;1 back pain is second only to mental illness as a reason for long-term work loss; and osteoarthritis is likely to overwhelm other chronic diseases as a cause of years lived with restricted activity in the future. This is hardly news for GPs. One-quarter of primary care consultations concern musculoskeletal aches and pains,2 a frequency only surpassed in UK general practice by consultations for respiratory problems.3 There are occasional success stories for biomedical approaches to these conditions; for example, when uncommon but important serious underlying causes, such as inflammation, are diagnosed and treated, or when a joint is replaced. But there are problems in applying traditional medical models to such common conditions. These models focus on the search for a diagnosis when what is needed for many patients in pain are ways to help them maintain function in their daily lives. Chronic pain management dominated by analgesic medication fails to address the role of activity and psychological and …