Doctors need to be more honest about persistent musculoskeletal pain with no obvious cause

Clinicians need to be more open about what people with persistent musculoskeletal pain with no obvious cause can expect, experts suggest in the British Journal of Sports Medicine.

There is no quick fix and people may ultimately have to live with their pain as they would any other long term condition, say Prof Jeremy Lewis and Prof Peter O’Sullivan

The danger is that sometimes structural changes often seen on the X-rays and scans of people with no pain, such as rotator cuff (muscles over the upper arm bone) tears and spinal disc degeneration, are used to explain the pain. This then leads to unnecessary surgery and/or avoidance behaviours.

The authors also highlight that some clinicians have arguably 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 Prof Jeremy Lewis and Prof Peter O’Sullivan.

The reality is that many musculoskeletal pain conditions are associated with disability and won’t respond to current (passive) treatments. And they should be managed in the same way as other long term conditions, such as diabetes. The focus should not be on providing a cure, but on minimising the impact on an individual’s wellbeing.

“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,” the authors say.

“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. By doing this, we can… be more honest with the level and type of care we can and should currently offer, and the outcomes that may be achieved.”

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