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A Protocol of Manual Tests to Measure Sensation and Pain in Humans
Published on: December 19, 2016
Diagnosing regional pain: the view from primary care
1Primary Care Sciences Research Centre, School of Postgraduate Medicine, Keele University, Staffordshire, UK.
Bailliere'S Clinical Rheumatology
|August 13, 1999
Summary
Primary care lacks evidence for musculoskeletal pain classification. The
Area of Science:
- Musculoskeletal pain diagnosis and management in primary care settings.
Background:
- Limited new evidence exists for practical diagnostic classifications of regional musculoskeletal pain in primary care.
- The 'red flag' system, successful in low back pain, shows potential applicability to other regional pain conditions.
Purpose of the Study:
- To evaluate the applicability of the 'red flag' system for initial management of regional musculoskeletal pain in primary care.
- To assess the utility of diagnostic labels, signs, and symptoms in primary care for regional pain syndromes.
Main Methods:
- Review of existing evidence and expert consensus on diagnostic classifications for regional musculoskeletal pain.
- Discussion of the 'red flag' system's principles and its potential adaptation for various regional pain conditions.
- Consideration of simple dichotomous classifications (articular vs. non-articular, acute vs. chronic) and non-specific chronic pain features.
Main Results:
- The 'red flag' system is proposed for identifying serious disease, guiding investigation or referral in regional pain.
- Routine use of many diagnostic signs, tests, and labels is discouraged in primary care due to low predictive value in the absence of red flags.
- Simple classifications (articular/non-articular, acute/chronic) and assessment of widespread pain are favored.
- Non-specific features of chronic pain may aid in managing regional syndromes.
Conclusions:
- The 'red flag' system offers a practical approach for initial management of regional musculoskeletal pain in primary care.
- Emphasis should be placed on identifying serious pathology and utilizing simple, evidence-based classifications rather than routine diagnostic labels.
- Further prospective studies are needed to determine the prognostic value of symptoms, signs, and diagnostic labels in regional pain syndromes.
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