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Title: Matching treatment options for risk sub-groups in musculoskeletal pain : a consensus groups study
Authors: Protheroe, Joanne
Saunders, Benjamin
Bartlam, Bernadette
Dunn, Kate M.
Cooper, Vince
Campbell, Paul
Hill, Jonathan C.
Tooth, Stephanie
Mallen, Christian D.
Hay, Elaine M.
Foster, Nadine E.
Keywords: Musculoskeletal Pain
Primary Care
Issue Date: 2019
Source: Protheroe, J., Saunders, B., Bartlam, B., Dunn, K. M., Cooper, V., Campbell, P., . . . Foster, N. E. (2019). Matching treatment options for risk sub-groups in musculoskeletal pain : a consensus groups study. BMC Musculoskeletal Disorders, 20(1), 271-. doi:10.1186/s12891-019-2587-z
Series/Report no.: BMC Musculoskeletal Disorders
Abstract: Background: Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Agreement was sought on treatment options for the five most common MSK pain presentations: back, neck, knee, shoulder and multisite pain, across three risk subgroups: low, medium and high. Methods: Three consensus group meetings were conducted with multi-disciplinary groups of practitioners (n = 20) using Nominal Group Technique, a systematic approach to building consensus using structured in-person meetings of stakeholders which follows a distinct set of stages. Results: For all five pain presentations, “education and advice” and “simple oral and topical pain medications” were agreed to be appropriate for all subgroups. For patients at low risk, across all five pain presentations “review by primary care practitioner if not improving after 6 weeks” also reached consensus. Treatment options for those at medium risk differed slightly across pain-presentations, but all included: “consider referral to physiotherapy” and “consider referral to MSK-interface-clinic”. Treatment options for patients at high risk also varied by pain presentation. Some of the same options were included as for patients at medium risk, and additional options included: “opioids”; “consider referral to expert patient programme” (across all pain presentations); and “consider referral for surgical opinion” (back, knee, neck, shoulder). “Consider referral to rheumatology” was agreed for patients at medium and high risk who have multisite pain. Conclusion: In addressing the current lack of robust evidence on the effectiveness of different treatment options for MSK pain, this study generated consensus from practitioners on the most appropriate primary care treatment options for MSK patients stratified according to prognostic risk. These findings can help inform future clinical decision-making and also influenced the matched treatment options in a trial of stratified primary care for MSK pain patients.
DOI: 10.1186/s12891-019-2587-z
Rights: © 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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