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A new model for treating musculoskeletal pain

Is it time to reframe how we care for people with non-traumatic musculoskeletal pain?” Oh, indeedy. This headline defies Betteridge’s Law of Headlines with a resounding yes.

This new editorial in the British Journal of Sports Medicine explains how musculoskeletal medicine has been chasing a lot of red herrings for the last few decades — all pitch perfect expert backup for everything I’ve ever said about “structuralism,” the excessive focus on crookedness and “mechanical” problems as causes of pain. But the authors also make refreshingly specific recommendations about how treatment needs to change. Although it’s a short piece, most of it’s behind a paywall, so I’ll quote the best part in full:

We believe there is a need to reframe the way we care for non-traumatic persistent and disabling musculoskeletal pain conditions, by aligning the management of such conditions with the principles underpinning the management of other chronic conditions: strong clinical alliance, education, exercise and lifestyle (sleep hygiene, smoking cessation, stress management, etc) in order to build the individual’s self-efficacy to take control and ultimately be responsible for their health. Although the arguments for such an approach are compelling, and evidence is emerging for a number of musculoskeletal disorders, it is acknowledged that definitive evidence for all musculoskeletal conditions is currently lacking.

Reframed in this manner, patients would no longer be led to expect a ‘magic’ manipulation or other passive approach to ‘cure’ their condition, and this in turn may reduce stress and burnout experienced by many clinicians who are unable to deliver on such unsubstantiated promises. Interventions such as manual therapy, pharmacology and injections, when provided, should be seen as an adjunct, and their risks and benefits must be considered and honestly communicated.

Excellent. The concession that evidence for this approach is lacking is important, of course… but it does offer something important that most treatment ideas in manual therapy have been haemorrhaging for thirty years now: PLAUSIBILITY.

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A new model for treating musculoskeletal pain

Orginally Published At: Pain Science

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