Three questions improve physicians' predictions of musculoskeletal pain treatment outcomes

Three questions can predict whether an older patient with musculoskeletal pain will still have pain six months later, a study found.

The prospective observational cohort study included 403 consecutive patients, age 50 or older, presenting to a general practice in the United Kingdom with noninflammatory musculoskeletal pain. The treating physicians asked the patients five questions about their pain and then recorded their own prognostic judgments. Patients were interviewed about their pain symptoms six months later, and researchers compared accuracy of the physicians' prognostication alone with a combination of their prognostication and some of the interview questions.

Results were published on May 13 by JAMA: Internal Medicine.

Three questions asked at the initial visit improved identification of patients who still had pain after six months:

• When was the last time you were free of pain for a month or more? (Less than three months or at least three months)
• In the last month, how much has this pain interfered with your daily activities, where 0 is no interference and 10 is unable to carry on? (0-4 or 5-10)
• Have you had pain anywhere else in the last month? (Yes or no)

Overall, 48.1% of the study participants still had pain at six months, and the combination of the indicators and physician judgment predicted 69% of them (C-statistic, 0.72 for combination vs. 0.62 for physician judgment). The questions improved prognostication by correcting physicians' tendency to predict overly optimistic outcomes, the researchers found.

The identification of these predictive, easy-to-obtain pieces of information could help with the “bewildering proliferation of tools developed for each of the many different syndromes and sites of musculoskeletal pain” and eventually lead to development of a risk score like those used to predict cardiovascular disease, the study authors said. Identification of patients who are likely to have long-term pain could allow physicians to target interventions at those who need them most, the study authors said.

An accompanying editorial noted that individualization of pain treatment is important and that overly optimistic prognostications can delay important discussions of factors that could influence long-term patient management, including depression and avoidance of activities.