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It can have a severe negative impact on your ability to perform every day tasks.

Simple movements like walking or working with your hands can cause major strain – on your body and overall wellbeing.

New guidelines to treat chronic musculoskeletal pain (CMSP) – developed by a researcher at Stellenbosch University, specifically in the South African context – promise to improve the treatment of the pain.

“CMSP is a global healthcare concern and affects people of different ages, genders and cultural groups. It is a key cause of disability and affects the health and quality of life of the individual,” explains Dr Dawn Ernstzen of the Division of Physiotherapy in SU’s Faculty of Medicine and Health Sciences.

Ernstzen recently obtained her doctorate in physiotherapy from SU, researching the manner in which CMSP is currently being treated in South Africa, as well as facilitators of and barriers to such treatment.

CMSP refers to pain associated with joints, muscles, tendons and nerves that persists for longer than 12 weeks, and thus beyond the expected healing time. It increases with age and can be symptomatic of various conditions, for example osteoarthritis, rheumatoid arthritis, spinal pain (e.g. lower back pain), tendon injuries and headaches. In some cases, the patient experiences the pain for years.

Having worked with many patients with chronic pain, Ernstzen says she wanted to contribute to easier access for healthcare workers and patients to treatment options for musculoskeletal care. She also wished to tell patients’ stories about how this pain influences them.

As part of her study, Ernstzen designed a clinical guideline framework to treat CMSP in South Africa, where a substantial proportion of people who seek primary healthcare do so because of musculoskeletal concerns.

Part of her research conducted amongst 20 patients (aged 30-70 years) and 21 clinicians (aged 23-63 years) at three different healthcare centres in the Western Cape, indicated that CMSP influences people’s ability to move their joints and perform everyday activities. It also influenced their general well-being and impacted their ability to participate in leisure activities and work.

Ernstzen used the information about practice patterns, barriers and facilitators to inform the guideline framework and render it specific to the South African context. The information was also used to develop a “model” clinical pathway for the treatment of patients who have been diagnosed with CMSP.

Her clinical guidelines contain statements about various interventions or strategies that can be used to treat CMSP. Some statements contain additional information that might influence decision-making about a particular intervention in the South African context.

“The guidelines highlight that CMSP should not be treated with medication alone, and that rehabilitation in the form of physical activity (exercise), psychological support and patient empowerment plays an important role in the management offered to the patient.

“The guidelines advocate a patient-centred approach, which may lead to a focus on patient-specific needs and enhanced patient satisfaction. Patient empowerment and education are some of the key recommendations, in order to empower patients with knowledge about their condition and ways to maintain their own wellness while living with this pain.”

According to Ernstzen, the guideline framework can provide quick solutions to clinicians about CMSP treatment options, as well as the evidence base for each treatment option.

“It provides a quick guide regarding recognised strategies to treat CMSP and easy access to up-to-date relevant information, which can save time and improve efficacy.”

The guidelines furthermore suggest a “model” pathway for patient care in the healthcare system, outlining the various healthcare practitioners that could be involved in treatment, such as nurses, doctors, physiotherapists, occupational therapists and mental health practitioners. This pathway for referring the patient from one practitioner to another can enhance efficacy and patient outcomes.

According to Ernstzen the clinical guidelines could potentially improve patient and also healthcare system outcomes, such as efficiency, cost and resources. But for this to happen, the guidelines should be implemented.

“Such implementation needs to be supported by policy and health systems and health policies should recognise CMSP as a chronic condition.

“Once implemented, the guideline recommendations could improve patients’ knowledge and understanding of the condition, enhance coping skills, strength and flexibility and improve functional abilities.”

Since more work needs to be done to finalise the guidelines, Ernstzen has set her sights on a pilot implementation within the next four years.

(Adapted from press release)