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It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice

2019; BMJ; Volume: 54; Issue: 8 Linguagem: Inglês

10.1136/bjsports-2018-100488

1473-0480

J.P. Cañeiro, Ewa M. Roos, Christian J. Barton, Kieran O’Sullivan, Peter Kent, Ivan Lin, Peter Choong, Kay M. Crossley, Jan Hartvigsen, Anne Smith, Peter O’Sullivan,

Sports injuries and prevention

Current clinical research, education and practice commonly approaches musculoskeletal pain conditions in silos. A focus on body regions such as knee, hip, neck, shoulder and back pain as separate entities is manifest by region-specific clinical guidelines, conferences and working groups. Emerging evidence demonstrates that musculoskeletal pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.1–5 There is broad consensus across clinical guidelines on the recommendations for best practice, irrespective of body region.3 We contend that a shift to focus on the person is needed. This best practice approach will encourage clinicians to (1) focus on patients’ context and modifiable biopsychosocial factors that influence their pain and disability3; (2) use education to facilitate active management approaches (targeted exercise therapy, physical activity and healthy lifestyle habits) and reduce reliance on passive interventions; and (3) consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. To adopt a person-centred active approach to treating musculoskeletal pain and disability, clinicians should: ### 1. Screen for biopsychosocial factors and health comorbidities Clinicians need to communicate clearly with the patient to identify potential biopsychosocial drivers of …