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J Pain. 2019 Dec 16. pii: S1526-5900(19)30876-4. doi: 10.1016/j.jpain.2019.11.014. [Epub ahead of print]

Management of Patients with a Musculoskeletal Pain Condition that is Likely Chronic: Results from a National Cross Sectional Survey.

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School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Montreal, Canada. Electronic address:
School of Rehabilitation Science, McMaster University, Hamilton, Canada; School of Rehabilitation, Physiotherapy Program University of Montreal, Montreal, Canada.
National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.


The purpose of the study was to explore clinical management for new cases of musculoskeletal pain that are likely chronic. We used data from the National Ambulatory Medical Care Survey, 2007-2015, identifying visits with a new chronic musculoskeletal pain condition using predetermined ICD-9 codes. We documented prescribing of nonopioid pain medication, opioids, physical therapy (PT), counseling, and other nonpharmacologic treatments and explored associations between patient and provider factors for each of these treatments. There were 11,994 visits over the 9-year period for a new case of chronic musculoskeletal pain, representing an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions that were prescribed nonopioid medication, opioids, PT, counseling and other nonpharmacologic treatments were: 40.2, 21.5, 10.0, 15.2 and 14.3 respectively. Patient age was associated with type of treatment with a young to old gradient for other nonpharmacologic treatments, PT, opioids, counseling and other medications. Orthopedists were less likely to prescribe pharmacological treatments than family practice physicians and more likely to prescribe PT. Physicians who used the electronic medical record were more likely to prescribe opioids. Contrary to practice guidelines for managing musculoskeletal pain, many patients are prescribed opioids for a new chronic musculoskeletal problem. PERSPECTIVE: We outlined in a representative sample of Americans what treatments are being prescribed for new cases of likely chronic musculoskeletal pain. Opioid prescription was double that of physical therapy. Using the electronic medical record was associated with more opioid prescription- a novel finding that should be corroborated by future research.


Chronic musculoskeletal pain; health services; management; nonpharmacologic treatment; pharmacologic treatment

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