Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?

Lewis, Jeremy; O’Sullivan, Peter

doi:10.1136/bjsports-2018-099198

Cited by 120 publications

(82 citation statements)

References 14 publications

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“…However, all patients presenting with musculoskeletal pain can benefit from education regarding the multidimensional complexity of musculoskeletal pain. Highlighting the important role that modifiable risk factors such as beliefs, physical activity, sleep and weight management play in their pain disorder provides opportunities for self-management 44. Recent research supports the long-term benefits of interventions that target these factors in people with hip and knee pain 45–47Table 4.…”

Section: Discussionmentioning

confidence: 99%

‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain

et al. 2020

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ObjectivesClinicians who use the biopsychosocial approach to manage musculoskeletal pain disorders aim to understand how patients make sense of their symptoms. Treatment includes targeting the negative beliefs and coping responses that can lead to progressive pain and disability. We aimed to explore how people seeking care for persistent hip pain and disability make sense of their symptoms.MethodsCross-sectional qualitative study. People were eligible if they were aged ≥18 years, were consulting an orthopaedic surgeon for persistent hip pain and offered a non-surgical intervention. Data were collected through interviews that explored patients’ beliefs about the identity (diagnosis), causes, consequences, timeline and controllability of their symptoms, their strategies to cope with pain and their experiences in seeking healthcare. Transcribed interview data were analysed thematically using a framework approach.ResultsSixteen people (median age=51, range=33–73 years; median duration hip pain=3 years, range=3 months–20 years) participated. Most participants (10/16) believed their pain was caused by an exercise-related injury. Because of the results of imaging and interactions with healthcare professionals, all participants believed they had damaged hip structures. All described ineffective strategies to manage their pain and multiple failed treatments. For many (7/16), a lack of control over symptoms threatened their physical and mental health.ConclusionsThe way participants with persistent hip pain and disability made sense of their symptoms contributed to them avoiding physical activity, and it impaired their sleep, emotional well-being and physical health.

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Section: Discussionmentioning

confidence: 99%

‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain

et al. 2020

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“…A holistic approach to care, with appropriate communication including reassurance and education, is likely to benefit patients but is poorly studied 27…”

Section: Understanding the Recommendationmentioning

confidence: 99%

Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Vandvik

Lähdeoja

Ardern

et al. 2019

BMJ

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Clinical questionDo adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery.Current practiceSAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations.RecommendationThe guideline panel makes a strong recommendation against surgery.How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on (a) the benefits and harms of subacromial decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC (www.magicapp.org) to support shared decisions and adaptation.The evidenceSurgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery.Understanding the recommendationThe panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.

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“…Clinicians working in primary care who are treating patients with SAPS should be aware that some patients experience prolonged symptoms and consider care strategies to support coping. [50][51][52] A placebo control helps answer the research question 'is there a benefit of subacromial decompression surgery?' because it minimises the risk of detection and performance biases.…”

Section: Inferences and Implicationsmentioning

confidence: 99%

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Lähdeoja¹,

Karjalainen²,

Jokihaara³

et al. 2019

Br J Sports Med

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Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?

Cited by 120 publications

References 14 publications

‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain

‘My hip is damaged’: a qualitative investigation of people seeking care for persistent hip pain

Subacromial decompression surgery for adults with shoulder pain: a clinical practice guideline

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

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