Executive Summary

This document is the outcome of a multi-disciplinary review of the scientific evidence for the diagnosis, prognosis and treatment of acute musculoskeletal pain. The evidence is summarised in the form of a management plan and key messages that may be used to inform practice. The aim in conducting an evidence review is to facilitate the integration of the best available evidence with clinical expertise and the values and beliefs of patients. The project was proposed and coordinated by Professor Peter Brooks, Executive Dean of the Faculty of Health Sciences, The University of Queensland. The guideline development process was overseen by a national steering committee and undertaken by multi-disciplinary review groups. Funding for the project was received from the Commonwealth Department ofHealth and Ageing. The evidence review was conducted according to standards outlined by the National Health and Medical Research Council (NHMRC) (1999a) and in accordance with ideas expressed by the pioneer of evidence-based medicine, Dr Archie Cochrane (1977). Cochrane proposed the rationalisation of interventions (both diagnostic and therapeutic) to promote those with evidence of safety and effectiveness. To that end he suggested: promoting diagnostic tests likely to have a beneficial effect on prognosis, evaluating existing interventions to exclude those shown to be ineffective or dangerous, and determining the place of interventions when there is insufficient evidence of benefit.

Rationale

Pain and disability associated with musculoskeletal conditions represent a significant health burden in Australia. Musculoskeletal disorders (arthritis, and musculoskeletal conditions including osteoporosis) cost Australia in excess of 15 billion dollars per annum, including direct and indirect costs (Access Economics 2001a,b). This evidence review complements the government's acknowledgement of the importance of arthritis and musculoskeletal conditions and their designation of this field as Australia's 7th national health priority area. The project aligns with the international Bone and Joint Decade initiative, and its two major Australian partners, Osteoporosis Australia and Arthritis Australia.

Within this context, this review of the scientific evidence for the management of acute musculoskeletal pain aims to promote informed and effective management of such pain, empower consumers and advance understanding of acute musculoskeletal pain through identification of research needs.

Summaries of this document have been developed for clinicians and for patients to promote a collaborative approach to decision-making. This approach is particularly important when a range of management options exists, as patients will bear the consequences of decisions affecting their health (Charles et al. 1999). The summary documents are available at http:// www.nhmrc.gov.au

Scope

• This document provides information on the management of acute pain, communication between clinicians and patients, and the diagnosis, prognosis and interventions for acute low back, thoracic spine, neck, shoulder and anterior knee pain.

• The document is concerned only with the management of acute episodes of pain (less than three months duration) that are not associated with specific diseases and serious conditions. Discussion of the management of specific conditions is beyond the scope of this document.

• Existing unpublished draft guidelines developed by the Australasian Faculty of Musculoskeletal Medicine formed the basis for the document. Multi-disciplinary groups undertook the work of updating the draft guidelines. Information on how the existing work was updated is provided in each topic.

• Where sufficient evidence has been available, recommendations have been made; however the aim of this work is to provide clinicians and patients with information to guide decisions rather than being prescriptive.

• This master document containing the review of evidence serves as the source for summary publications for clinicians and patients. Same-source information promotes partnership in decision-making and facilitates the provision of informed consent.

• This document is not intended to, nor should there be any implication that it would be used in a regulatory fashion to dictate practice.

• The results of economic evaluations and cost information are included, where possible, to promote consideration of the efficient distribution of resources.

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