Matching treatment options for risk sub-groups in musculoskeletal pain: a consensus groups study

Area of Science:

• Orthopedics
• Pain Management
• Primary Care Medicine

Background:

• Musculoskeletal (MSK) pain presents a significant global healthcare challenge.
• There is a need for evidence-based primary care treatment guidelines for MSK pain.
• This study focused on common MSK conditions: back, neck, knee, shoulder, and multisite pain.

Purpose of the Study:

• To achieve practitioner consensus on optimal primary care treatments for MSK pain.
• To stratify treatment recommendations based on prognostic risk of persistent disabling pain.
• To inform clinical decision-making and guide trials of stratified primary care for MSK pain.

Main Methods:

• Utilized the Nominal Group Technique (NGT) for structured consensus building.
• Conducted three in-person meetings with multi-disciplinary practitioner groups (n=20).
• Sought agreement on treatment options for five common MSK pain presentations across three risk subgroups (low, medium, high).

Main Results:

• Education, advice, and simple analgesics were agreed for all risk groups and pain types.
• Low-risk patients: review by primary care practitioner if not improving after 6 weeks.
• Medium-risk patients: consider physiotherapy or MSK-interface-clinic referral.
• High-risk patients: consider opioids, expert patient programs, or surgical opinions, with rheumatology referral for multisite pain.

Conclusions:

• Generated practitioner consensus on primary care treatment options for MSK pain, stratified by prognostic risk.
• Findings address the lack of robust evidence for MSK pain treatment effectiveness.
• Recommendations can inform clinical practice and stratified care trials for MSK pain patients.