When you seek care from a health professional with low back pain, neck pain, arthritis, or shoulder pain, what care should you receive and what care should you not receive in order to result in the best outcomes?
These conditions, collectively known as musculoskeletal pain problems, are amongst the most common health concerns for Australians.
“Musculoskeletal pain is not only very common, but it results in the most disability of any health issue in Australia and internationally” said lead researcher Dr Ivan Lin.
“For health care professionals and health care systems the challenge is understanding the best way to manage these conditions”.
This was the question that a team of leading Australian researchers and clinicians from the University of Western Australia, Curtin University, University of South Australia, University of Sydney, Harry Perkins Institute of Medical Research, Sir Charles Gardner Hospital, and Geraldton Hospital recently sought to answer.
The group summarised the results of recent high quality clinical guidelines for musculoskeletal pain conditions including low back pain, neck pain and whiplash, osteoarthritis of the hip and knee, and shoulder pain.
They identified 11 common recommendations for care:
- care should be patient-centred, such as incorporating effective communication and involving the patient in decision making;
- screen for ‘red flag’ (serious conditions) such as fractures, cancer or conditions masquerading as musculoskeletal pain;
- assess psychosocial factors such as depression, anxiety or unhelpful beliefs about pain as they are common predictors of poorer outcomes and require special care;
- only use radiological imaging when there is a suspicion of a ‘red flag’ condition;
- undertake a physical examination to assess physical capacity and neurological problems;
- monitor patient progress, for example with a wellbeing questionnaire;
- provide education/information about pain and management;
- giving advice about activity or exercise;
- only using manual therapies, such as joint manipulation or massage, with other treatments such as exercise;
- offering high quality non-surgical care, such as rehabilitation, prior to surgery;
- and encouraging patients to continue work if they are employed.
The study also identified treatments for certain conditions that should not be provided. For example, patients with low back pain should not be prescribed opioid-based medications or Panadol alone, given rocker shoes or orthotics, receive disc replacement surgery, or injections into the back when there was no leg pain associated with back pain. Patients with osteoarthritis should be wary of having arthroscopic knee surgery.
Specialist pain physician and study team member Dr Roger Goucke says that following these recommendations would improve outcomes for patients.
“If these recommendations were followed when patients first sought care we would see less patients in trouble later on in the pain clinic,” Dr Goucke said.
According to lead researcher Dr Ivan Lin the real challenge now is how to implement these recommendations into usual care.
“We know what care needs to be provided but in many cases, patients are receiving the opposite of this. Changing this situation is what keeps our team and others very busy”.
View the full paper here - http://bit.ly/2NWa2AZ
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