Abstract
BackgroundMusculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Agreement was sought on treatment options for the five most common MSK pain presentations: back, neck, knee, shoulder and multisite pain, across three risk subgroups: low, medium and high.MethodsThree consensus group meetings were conducted with multi-disciplinary groups of practitioners (n = 20) using Nominal Group Technique, a systematic approach to building consensus using structured in-person meetings of stakeholders which follows a distinct set of stages.ResultsFor all five pain presentations, “education and advice” and “simple oral and topical pain medications” were agreed to be appropriate for all subgroups. For patients at low risk, across all five pain presentations “review by primary care practitioner if not improving after 6 weeks” also reached consensus. Treatment options for those at medium risk differed slightly across pain-presentations, but all included: “consider referral to physiotherapy” and “consider referral to MSK-interface-clinic”. Treatment options for patients at high risk also varied by pain presentation. Some of the same options were included as for patients at medium risk, and additional options included: “opioids”; “consider referral to expert patient programme” (across all pain presentations); and “consider referral for surgical opinion” (back, knee, neck, shoulder). “Consider referral to rheumatology” was agreed for patients at medium and high risk who have multisite pain.ConclusionIn addressing the current lack of robust evidence on the effectiveness of different treatment options for MSK pain, this study generated consensus from practitioners on the most appropriate primary care treatment options for MSK patients stratified according to prognostic risk. These findings can help inform future clinical decision-making and also influenced the matched treatment options in a trial of stratified primary care for MSK pain patients.
Highlights
Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden
Individual general practice (GP) treatment is highly variable [3], which may be in part due to a lack of confidence in managing these problems [4], as well as MSK pain being given lower priority when compared with other acute illnesses with more medically critical symptoms [5, 6]
Participants had a range of clinical backgrounds, with a mix of experience levels/ length of time in practice (2–27 years in current clinical role; mean = 12 years)
Summary
Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Stratified primary care has been shown to be clinically and cost effective for low back pain [10,11,12] This approach involved the use of a brief self-report tool− the STarT Back tool [13], to identify patients’ risk of persistent disabling pain, and matching risk subgroups (i.e. low, medium and high risk) to appropriate first-line treatment options. Using this approach, patients who need more intensive treatment are identified at the outset, allowing them to be ‘fast-tracked’ to that treatment, whilst patients at low risk can be reassured of their good prognosis and unnecessary treatments can be avoided.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
