It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice

Cañeiro, J P; Roos, Ewa M.; Barton, Cole; O’Sullivan, Kieran; Kent, Peter; Lin, Ivan; Choong, Peter; Crossley, Kay M; Hartvigsen, Jan; Smith, Anne; O’Sullivan, Peter

doi:10.1136/bjsports-2018-100488

Cited by 74 publications

(57 citation statements)

References 16 publications

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“…In recent years, there has been a growing body of evidence recommending specific approaches to facilitate adoption of the biopsychosocial model of health into routine clinical practice [40,41]. Specifically, clinicians have been advised to 1) adopt open and reflective questioning surrounding a patient's experiences, beliefs, biopsychosocial factors, and expectations; 2) set shared goals and discover the patient's related concerns and limitations; 3) educate beyond words using active learning approaches to facilitate behaviour change; and 4) coach towards self-management using support through understanding, reassuring, and empowerment.…”

Section: Adopting the Biopsychosocial Model: A Way Forwardmentioning

confidence: 99%

“It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy

et al. 2020

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Background Achilles tendinopathy (AT) is a common and often persistent musculoskeletal disorder affecting both athletic and non-athletic populations. Despite the relatively high incidence there is little insight into the impact and perceptions of tendinopathy from the individual's perspective. Increased awareness of the impact and perceptions around individuals' experiences with Achilles tendinopathy may provide crucial insights for the management of what is often a complex, persistent, and disabling MSK disorder. Purpose To qualitatively explore the lived experiences of individuals with AT. Design A qualitative, interpretive description design was performed using semi-structured telephone interviews. Methods Semi-structured interviews were conducted on 15 participants (8 male and 7 female) with AT. Thematic analysis was performed using the guidelines laid out by Braun and Clarke. The study has been reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.

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Section: Adopting the Biopsychosocial Model: A Way Forwardmentioning

confidence: 99%

“It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy

et al. 2020

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“…Patients with CSP were recruited, because this is the most prevalent location of CMP in the population [3,74]. Moreover, the mechanisms involved in the perpetuation of CMP are common regardless of the body region where the pain is located [75].…”

Section: Introductionmentioning

confidence: 99%

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

Galán-Martín

Montero-Cuadrado²,

Lluch-Girbés

et al. 2020

JCM

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Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.

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“…In addition, patients with NP and LBP have several similarities in psychosocial prognostic factors and comorbidities, clinical guidelines for best practice, and lack of specific pathoanatomic causality [11][12][13][14]. While the models for clinical management of musculoskeletal complaints to date have mainly been condition specific, there have recently been calls for management based on characteristics within the biopsychosocial model regardless of pain condition [14][15][16][17]. Studies have also demonstrated that patients with trajectories of NP display similar on most health-related factors as for LBP [5,6].…”

Section: Introductionmentioning

confidence: 99%

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

Irgens

Kongsted

Myhrvold

et al. 2020

BMC Musculoskelet Disord

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Background Neck and low back pain represent dynamic conditions that change over time, often with an initial improvement after the onset of a new episode, followed by flare-ups or variations in intensity. Pain trajectories were previously defined based on longitudinal studies of temporal patterns and pain intensity of individuals with low back pain. In this study, we aimed to 1) investigate if the defined patterns and subgroups for low back pain were applicable to neck pain patients in chiropractic practice, 2) explore the robustness of the defined patterns, and 3) investigate if patients within the various patterns differ concerning characteristics and clinical findings. Methods Prospective cohort study including 1208 neck pain patients from chiropractic practice. Patients responded to weekly SMS-questions about pain intensity and frequency over 43 weeks. We categorized individual responses into four main patterns based on number of days with pain and variations in pain intensity, and subdivided each into four subgroups based on pain intensity, resulting in 16 trajectory subgroups. We compared baseline characteristics and clinical findings between patterns and between Persistent fluctuating and Episodic subgroups. Results All but two patients could be classified into one of the 16 subgroups, with 94% in the Persistent fluctuating or Episodic patterns. In the largest subgroup, “Mild Persistent fluctuating” (25%), mean (SD) pain intensity was 3.4 (0.6) and mean days with pain 130. Patients grouped as “Moderate Episodic” (24%) reported a mean pain intensity of 2.7 (0.6) and 39 days with pain. Eight of the 16 subgroups each contained less than 1% of the cohort. Patients in the Persistent fluctuating pattern scored higher than the other patterns in terms of reduced function and psychosocial factors. Conclusions The same subgroups seem to fit neck and low back pain patients, with pain that typically persists and varies in intensity or is episodic. Patients in a Persistent fluctuating pattern are more bothered by their pain than those in other patterns. The low back pain definitions can be used on patients with neck pain, but with the majority of patients classified into 8 subgroups, there seems to be a redundancy in the original model.

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It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice

Cited by 74 publications

References 16 publications

“It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy

“It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

Neck pain patterns and subgrouping based on weekly SMS-derived trajectories

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