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

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Editorial
It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice
  1. J P Caneiro1,2,
  2. Ewa M Roos3,
  3. Christian J Barton4,
  4. Kieran O'Sullivan5,
  5. Peter Kent6,7,
  6. Ivan Lin8,
  7. Peter Choong9,
  8. Kay M Crossley4,
  9. Jan Hartvigsen3,
  10. Anne Julia Smith1,
  11. Peter O'Sullivan1
  1. 1 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  2. 2 Body Logic Physiotherapy Clinic, Perth, Western Australia, Australia
  3. 3 Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  4. 4 School of Allied Health, La Trobe University and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
  5. 5 University of Melbourne Department of Surgery, St Vincent’s Hospital, Melbourne, New South Wales, Australia
  6. 6 Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  7. 7 School of Allied Health, University of Limerick, Limerick, Ireland
  8. 8 Ageing Research Centre, University of Limerick, Limerick, Ireland
  9. 9 Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
  1. Correspondence to Dr J P Caneiro, Physiotherapy, School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA 6102, Australia; jp.caneiro{at}postgrad.curtin.edu.au

https://doi.org/10.1136/bjsports-2018-100488

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    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.

    We recommend five actions to manage a person with musculoskeletal pain, irrespective of body region

    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 …

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