What is musculoskeletal pain?

Musculoskeletal Pain is simply an unpleasant sensory or emotional experience arising from actual or perceived damage to your muscles, joints, ligaments, and tendons.

With that overly academic definition out of the way, today’s post is not so much about what pain is, we’ll tackle that in another post, rather we would like to call out poor quality healthcare and give you 11 high-quality recommendations that we’ll apply when looking at your pain-related issues.

These recommendations come from a review of all Clinical Practice Guidelines published on various topics related to musculoskeletal pain by Ivan Lin and colleagues in 2019. These researchers found a total of 44 articles and compiled their best advice into a core set of best-practice recommendations.

Common problems.

We won’t dwell on this for too long, we’d like to keep today’s post positive and optimistic, but Lin and colleagues found there was an overuse of radiological imaging (X-rays, CTs, and MRIs), surgery, and opioid prescription, and failure to provide top-notch education and advice. Sadly, this research group wasn’t the first to point this out and there have been others since who have highlighted these behaviors, which means healthcare providers are still making the same mistakes that cost people valuable time and resources.

Now, this doesn’t mean that imaging, opioids, and surgery are unnecessary or inappropriate. It means we need to do better at thoroughly exploring other options before taking more drastic (and potentially harmful) measures.

The solution.

Care that is in line with best-practice recommendations is proven to achieve better outcomes at a lower cost. Win-win! That’s the post. No more to say.

So, what are they?

  1. Care should be patient-centered: acting as a supportive guide, acknowledging and responding to individual contexts, expectations, and preferences, and working together with a shared-decision making approach.
  2. Patients should be routinely screened for serious pathologies (e.g. blood tests): sometimes there will be a specific problem that will require further investigation or more complex care.
  3. Psychosocial factors should be assed and managed: our minds and bodies don’t exist in isolation; we need to look at the complete picture.
  4. Radiological imaging (e.g. x-rays) is discouraged in most circumstances, unless there are obvious clues that something weird is going on.
  5. Thorough physical assessments should be conducted: to find a pattern that may explain your problems and serve to guide recovery.
  6. Progress should be tracked and reviewed: how else do we know if you’re getting better or not?
  7. It’s important to ensure patients are adequately educated about their condition and the best management options.
  8. Management that addresses physical activity and exercise should be provided: honestly, we could all do with moving more.
  9. Manual therapies should only be utilised as an adjunct to other evidence-based treatments: change is in the doing and the doing is done by you.
  10. Unless there is a clear reason, evidence-informed non-surgical care prior to surgery should be utilised
  11. Continuation or resumption of work should be facilitated and other meaningful activities from as early as possible.

There is a lot to pull apart in each of these recommendations, but we hope that laying them out for your consideration like this will help you make more informed choices that should lead to better outcomes. It’s worth knowing these recommendations have been compiled based on evidence for neck, back, and shoulder pain, but they have received overwhelming support for all musculoskeletal issues until more specific needs are required.

As always, our promise is to be positive, passionate, and progressive in our care to you and these 11 recommendations are a great example of how we stay true to this ethos. If you’re struggling to get on top of an old lingering pain issue or recently experienced a new injury, we’ll use these guiding principles to help you get back on track.

Book an appointment here.

Interested in learning more? Sign up to our ‘What does best practice care for musculoskeletal pain look like?’ webinar here.

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., … & O’Sullivan, P. P. (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), 79-86.

Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., … & Bhutta, Z. A. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204-1222.

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