Oct 07th 2021

Coordination of Care for Musculoskeletal Conditions

Musculoskeletal pain is now recognized as a national public health problem. While estimates vary depending on the methodology used to assess pain, there is general agreement that more than 1.7 billion people worldwide suffer from musculoskeletal conditions. Because of the variation in these conditions, such as which part of the body is affected, whether the pain is acute or chronic, and the patient’s existing overall state of health (to name a few), numerous treatment options exist to help patients address the root cause of their pain. As a result, the coordination of care regarding the types of treatments tried and the optimal selection of providers is increasingly important. This article explores some of these factors and how they may positively affect clinical outcomes.

Because every musculoskeletal pain patient is different, there's no one-size-fits-all treatment path. This is both a challenge and an opportunity for providers treating musculoskeletal conditions, and coordination of care—how you move the patient forward—makes a difference.

For example, for many patients there are a number of modalities to consider before going the route of surgery or prescription pain medications:

·       What is the role of the primary care provider for this patient’s care?

·       Have any medications already been prescribed? How well are they working?

·       When should conservative care be started, or has it already begun? How long should these treatments last? Should patients stay with the same type of provider for an extended period of time?

·       Should the patient go right to a surgeon, or see a pain management specialist next? What about other conservative care providers, such as physical therapists or chiropractors?

Keep in mind: even before patients arrive for the first consult, they may have done some research online, asked another provider for recommendations or advice, or reached out to family and friends to hear about their experiences in seeking care.

Ultimately, every treatment path has a starting point. And when you're evaluating how to treat musculoskeletal pain, that starting point is key to the coordination of care as the patient moves forward.

Starting with conservative care for musculoskeletal pain

Successful care coordination for patients experiencing musculoskeletal pain goes hand in hand with conservative care. In addition to curbing unnecessary care and costs, it's often connected to better patient outcomes.

When it comes to treating lower back pain, research has shown that patients who received advanced imaging before trying a trial of conservative care, such as physical therapy, incurred higher costs by an average of $4,800. The increased costs do not always correlate with improved outcomes, since the advanced imaging often does not identify the actual cause of a patient's pain, such as disc degeneration, arthritis, bulging discs, or other structural causes.

Rather than funneling patients directly to invasive and costly care such as surgery, injections, or further testing, conservative treatments—such as physical therapy, chiropractic care, acupuncture, and yoga, possibly in tandem with behavioral health services—may be equally if not more effective in treating the pain without medication. An added positive outcome? Over time, these treatments can actually improve mobility and quality of life.

Better access to direct care for musculoskeletal conditions

While the long-term outcomes of conservative care may be better for the patient, the reality is the different treatment modalities take time to achieve the desired results, and a number of approaches may be tried before finding the right fit.

Since the patient is already in pain, facilitating access to conservative care services is very helpful in assisting the patient in pursuing less invasive treatment options and achieving earlier pain relief. Earlier referral to physical therapy is one way to support this trajectory and get them further along the road to recovery. Engaging the patient in physical therapy also supports the goal of getting to the root cause of the pain, rather than simply masking it with medication.

How to treat musculoskeletal pain without fostering opioid dependence

The number of Americans reporting chronic pain is staggering: 116 million suffer from the debilitating effects of musculoskeletal conditions like fibromyalgia, lower back pain, or hip/knee osteoarthritis.

By beginning with conservative care services such as physical therapy, acupuncture, or behavioral health services, patients are better equipped to manage their pain without resorting to opioids. When such medications are needed, these care services also help avoid the negative side effects and risks that can come with opioid use—including depression, addiction, overdose, and the potential for dangerous withdrawal symptoms.

Reduced costs and coordination of care for musculoskeletal conditions

Better compliance. More follow-through. Accountability and engagement. Earlier and more longstanding pain relief.  Providers want these outcomes for their patients, and coordination of care is critical in driving these results.

A better provider-patient partnership—often a byproduct of coordination of care— can impact costs savings as well, because the patient is more likely to commit to wellness over just a quick fix. These "quick fixes"—such as injections or prescription pain medications—can reduce quality of life and increase out-of-pocket expenses.

The bottom line? Effective pain management that improves a patient's quality of life, reduces costs for all involved, and disrupts the vicious cycle of opioid dependency is worth the effort—and it all starts with coordination of care.

Sources:

https://www.cdc.gov/drugoverdose/pdf/pharmacists_brochure-a.pdf

https://www.spine-health.com/treatment/chiropractic/chiropractic-treatments-lower-back-pain

https://www.choosept.com/health-tips/physical-therapy-vs-opioids-when-to-choose-physical-therapy-pain-management