Doctors must be more honest with patients about persistent musculoskeletal pain with no obvious cause – because it cannot be cured, according to two experts today.
Professor Jeremy Lewis, of the University of Hertfordshire and Central London Community Healthcare NHS Trust, and Professor Peter O’Sullivan, of Curtin University, Perth, and Bodylogic Physiotherapy, Perth, Australia, say in their editorial published online in the British Journal of Sports Medicine that there is no magic fix.
The authors suggest that most persistent musculoskeletal pain, which is not the result of injury or trauma, has prompted two unfortunate trends.
First, they say that structural changes commonly seen on the x-rays and scans of people with no pain, such as rotator cuff tears and intervertebral disc degeneration, are often used to explain the pain. This could lead to unnecessary surgery on tendons, cartilage and bones that are not the cause of the pain.
The authors also claim that some clinicians have invented treatments for conditions that may not actually exist or be readily detected, and for which there is no good evidence that they work.
“These two trends have created an expectation that interventions (frequently ‘passive’) will provide a ‘cure,’ and typically quickly, with minimal self-contribution,” write the authors.
However, many musculoskeletal pain conditions are associated with disability and will not respond to current treatment. Instead, they should be managed in the same way that other long-term conditions are.
“We need to reframe what is currently doable and achievable in the management of many non-traumatic musculoskeletal presentations, and honest and open conversations regarding the outcome evidence for these disorders needs to be sensitively communicated,” they argue.
“For patients, creating an understanding and expectation that, as with other chronic health conditions, there is no magic cure for persistent and disabling musculoskeletal pain conditions…is the key.”
Editorial: Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? British Journal of Sports Medicine June 2018; doi 10.1136/bjsports-2018-099198
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