Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

Abstract

Background & aimsMusculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.MethodsA systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.ResultsModerate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.ConclusionThis review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.

Stratified primary care versus non-stratified care for musculoskeletal pain: findings from the STarT MSK feasibility and pilot cluster randomized controlled trial

“…The Keele STarT MSK Tool has shown good predictive and discriminative ability in development and validation samples [38], identifying patients at low, medium or high risk of persistent MSK pain over 6months. Using systematic review and consensus methods, we also agreed evidence-based recommended matched treatment options for each of the risk subgroups [39,40].…”

Short‐term swimming exercise attenuates the sensitization of dorsal horn neurons in rats with NGF‐induced low back pain

“…Non-specific low back pain is one of the most common chronic pain conditions (Balagu e et al, 2012), and exercise of the low back has been shown to be an effective physical therapy (Shi et al, 2018). Exercise and other forms of physical therapy are approved therapeutic treatment strategies in the rehabilitation of patients suffering from chronic pain including low back pain (Heneweer et al, 2009;Hooten et al, 2012;Babatunde et al, 2017;Geneen et al, 2017). Physical therapy reduces pain reactions in animals (Cobianchi et al, 2010;Shen et al, 2013;Sluka et al, 2013;Santos et al, 2014;Lima et al, 2017) and pain in humans (Naugle et al, 2012;Babatunde et al, 2017).…”

Evidence flowers: An innovative, visual method of presenting “best evidence” summaries to health professional and lay audiences

“…The large, independent evidence syntheses conducted for STarTMSK and ENHANCE research programmes, composed of systematic searches of bibliographic databases (including Cochrane database of systematic reviews, Database of abstracts of reviews of effects, Health Technology Assessment database, MEDLINE and EMBASE [using specific search filters to retrieve systematic reviews and clinical guidelines]), and evidence sources (Clinical Knowledge Summaries, Map of Medicine, TRIP Database, reference lists of included systematic reviews and guidelines, research stakeholders, and experts in the field) for the most recent, high quality reviews, clinical guidelines, and policy documents. The evidence syntheses used pre‐appraised evidence, such as clinical guidelines, policy documents, clinical evidence pathways, and evidence summaries, wherever possible as the starting point due to the broad topic areas being addressed, similar to the 6s pyramid model described by Dicenso et al The methods and results of these syntheses has been published elsewhere …”

“…The evidence syntheses used preappraised evidence, such as clinical guidelines, policy documents, clinical evidence pathways, and evidence summaries, wherever possible as the starting point due to the broad topic areas being addressed, similar to the 6s pyramid model described by Dicenso et al 26 The methods and results of these syntheses has been published elsewhere. 23,27 Information from evidence syntheses can be complex with multiple aspects to consider. Risk of bias and confounding, strength of recommendations, design of primary sources of data, magnitude of effect, level of precision, directedness, the dose response gradient of evidence, and consistency of results across sources of evidence may all affect interpretation of the evidence.…”