MUSCULOSKELETAL MATTERS – BULLETIN 11
Patterns of multi-site pain consultations in general practice
We studied patients with one particular syndrome
of multi-site pain (‘chronic widespread pain’
or ‘CWP’) who consult for combinations of
musculoskeletal pain over time across a number
of sites.
Our study definition of CWP was based on
patterns of musculoskeletal consultations over
5 years:
At least one consultation for neck or back
Figure 1 - Self-reported symptoms
80
CWP
No CWP
60
%
40
20
0
Chronic
pain
Anxiety/
depression
Migraine/
headache
Chest
symptoms
Poor sleep
+
At least one consultation for upper or lower limb
+
At least one consultation in 3 separate years
+
At least four consultations in total
Results
y y Patients with CWP made up 3% of
registered adults.
y y Compared to matched controls with no
musculoskeletal consultation:
Patients with CWP reported -
More health problems (Figure 1)
Higher levels of fatigue
Worse general health
Greater sleep disturbance
More severe symptoms
Patients with CWP were more likely to also
consult for -
Anxiety / depression
Dizziness / neurological
symptoms
Fatigue
Gastrointestinal conditions
Headache
Key messages – primary care
Patients regularly presenting to primary
care with musculoskeletal pain problems
in different sites exhibit other known
characteristics of chronic widespread pain
This includes reporting and consulting for a
range of health problems
General pain management approaches, rather
than separate treatments for each pain site,
may improve outcome
Recommendations
CLINICAL: consider
y y asking about other pains in people
presenting with single-site pain
y y if people presenting with single-site
musculoskeletal pain have CWP
y y asking about other health problems in
people presenting with pain
y y identifying patients whose treatment can
be directed at more than the presenting
single site of pain
POLICY: consider providing enhanced pain
services for people with multi-site pain and CWP
RESEARCH: identify best practical targeted
treatments classified by number of pain sites
References
Lacey et al. Clustering of pain and impact on health in older people: results from the North Staffordshire Osteoarthritis Project (NorStOP).
BMJ Open 2015;5:e008389. doi:10.1136/bmjopen-2015-008389.
Rohrbeck et al. The frequency and characteristics of chronic widespread pain in general practice: a case-control study. British Journal of
General Practice, 2007;57:109-115.
Funders: Medical Research Council (G0501798); Primary Care Research West Midlands North; North Staffordshire Primary Care Research &
Development Consortium; North Staffordshire Medical Institute.
These Bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about
musculoskeletal problems in practice.
For more information on these bulletins please visit:
www.keele.ac.uk/pchs/disseminatingourresearch/newslettersandresources/bulletins