Take Home Messages:

Musculoskeletal pain problems affecting different parts of the body sites share similar underlying features and clinical courses.

In the primary care setting, common factors including specific pain characteristics at consultation, psychosocial factors and increased levels of disability can assist in identifying those patients with musculoskeletal pain who are at risk of a poor outcome, irrespective of the specific location of their pain.

Why the research matters:

Musculoskeletal pain is a common reason for consulting a primary care doctor. An understanding of the factors that influence the clinical course of musculoskeletal conditions is important as it allows the practitioner to inform the patient of the likely outcome of their condition and to develop an appropriately tailored pain management plan.

While research has identified factors that may help to predict the outcome of musculoskeletal pain, these studies have typically examined pain at specific anatomical sites and have not assessed whether any outcome indicators are common to musculoskeletal pain regardless of the site affected.

What the research involved:

Researchers from the Primary Care Musculoskeletal Research Centre in Staffordshire in the United Kingdom reviewed published studies to identify factors that appear to predict poor outcomes for patients with musculoskeletal pain at different sites.

Studies included in the review were of a prospective, observational design and were undertaken in the primary care setting in adults with regional or multiple site musculoskeletal pain. The quality of each study was also assessed against a range of criteria related to internal and external validity.

A total of 45 studies were included in the review. These studies ranged in size from 44 to 3,197 subjects and examined prognostic factors for musculoskeletal pain affecting the following sites:

• Back pain (27 studies;
• Spinal pain (6 studies);
• Shoulder and/or shoulder-neck pain (4 studies;
• Hip pain (2 studies;
• Elbow pain (1study);
• Knee pain (1study); and
• General musculoskeletal pain (4studies).
   

Summary of research findings:

In total, 63 different prognostic indicators were identified that were investigated in at least one study and were shown to be associated with patient outcomes. Of these, eleven prognostic factors were identified that were associated with poor outcome at follow-up for musculoskeletal pain affecting different anatomical sites:

• Increased severity of pain at baseline;
• Longer pain duration;
• Pain at multiple sites;
• Previous pain episodes;
• Anxiety and/or depression;
• Higher somatic perceptions and/or distress;
• Adverse coping strategies;
• Low social support;
• Older age;
• Higher disability at baseline; and
• Greater restriction of movement.

Original research:

Prognostic factors for musculoskeletal pain in primary care: a systematic review.
Mallen CD, Peat G, Thomas E, Dunn KM, Croft PR.
Brit J Gen Pract 2007; 57: 655-61.

Link to PubMed abstract.