Regional musculoskeletal pain in the low back, neck, shoulder or knee is among the most common reason people seek health care in Australia. The majority of these presentations only require reassurance and advice, as they are likely to improve quickly without treatment. However, new research by Monash University has suggested a high proportion have tests, treatments and referrals that may be unnecessary.
The study of 133,000 patients, found that around one third of people presenting to GPs with regional musculoskeletal symptoms received early imaging, an opioid prescription and/or a referral to another health care practitioner. Fourteen percent of these referrals were to a surgeon.
Lead researcher Professor Rachelle Buchbinder – a speaker at this year’s Health Insurance Summit – says many of these interventions are avoidable and could cause unintended harm.
Around half of the patients presenting with knee pain, for example, are referred for MRIs or CT scans. These tests can detect benign findings that are normal signs of ageing, but which are often assumed to be the cause of pain, sparking unnecessary concerns or diagnoses.
“Tests like CT and MRI scans are very sensitive and pick up all sorts of things, many of which are normal for age. But sometimes these are erroneously blamed as the cause of a person’s symptoms. The problem is that often you can’t tell if they are responsible or not, as these findings are almost as common in people without symptoms,” Prof Buchbinder told Informa Connect ahead of her speech.
“For example, someone’s spine might show signs of degeneration, or their knee might have a meniscal tear and have lots of scary sounding medical terminology associated with it. This can be alarming for patients and their doctors, even though it is a normal part of ageing. It can then lead to unnecessary treatments such as knee arthroscopy, which have lots of risks, but moderate to high certainty evidence that they provide minimal to no benefits over non-operative treatments.”
Opioids, too, are often over-prescribed in response to musculoskeletal pain Prof Buchbinder says. These are not very effective and have well-known risks.
“We know opioids aren’t that helpful for musculoskeletal pain, so it is very concerning that 36 percent of patients presenting with this type of pain have them prescribed. They are also highly addictive and have a range of adverse consequences,” she said.
A different way
In addition to the study, Prof Buchbinder and her team in the Wiser Healthcare Collaboration, have been working closely with the federal government to improve the way musculoskeletal pain is managed.
As part of this work, they have helped the government design letters to “high requesters” of musculoskeletal referrals. This resulted in fewer GPs sending queries or complaints to the Department, when compared with previous versions of the letter.
Prof Buchbinder says this is encouraging, as it shows the messaging surrounding over-diagnosis and intervention within musculoskeletal pain is sinking in.
“It is counter-intuitive that requesting fewer tests is a better way to manage patients’ health, and it can be hard to convey this to patients. But we need to do a better job of explaining why tests are not needed and why they may do more harm than good. My hope is that we can optimise care for people with these common health complaints to improve their outcomes.”
About Professor Buchbinder
Professor Rachelle Buchbinder combines rheumatology practice with clinical research. She is an NHMRC Investigator Fellow and a Professor in the Monash University School of Public Health and Preventive Medicine.
She is known internationally as a vocal proponent of evidence-based medicine and for her landmark studies, particularly those examining treatments accepted into practice before their proper evaluation. She was appointed an Officer of the Order of Australia (AO) for services to epidemiology and rheumatology in 2020.
Her book, ‘Hippocrasy, how doctors are betraying their oath’, written with Professor Ian Harris (a Sydney-based orthopaedic surgeon), and with support from a Rockefeller Foundation writing fellowship at the Bellagio Center in Italy, was published at the end of 2021.
Hear more insights from Prof Buchbinder at the Health Insurance Summit, where she will give expert recommendations on how musculoskeletal pain could be better managed.
Joining Rachelle on the stage are representatives from Australian Government, RACGP, Medibank, nib and many others.
This year’s event will be held 27-28 June 2023 at the Amora Hotel Jamison, Sydney.
Learn more and register here.