Acute cervical spine pain in primary care.

BACKGROUND: Acute cervical spine pain is a common presentation to primary care practitioners. OBJECTIVE: The aim of this paper is to describe an approach to the assessment and management of the common presentations of acute cervical spine pain. DISCUSSION: Taking a biopsychosocial approach to pain is important as a general rule, and especially with acute cervical spine pain. A general structured overview of assessment and management is outlined. A pathoanatomical diagnosis is rarely needed in the acute situation in the absence of red flags. The focus is on an early comprehensive assessment, followed by an individualised management plan. Allied health involvement in an interdisciplinary context needs consideration for patients with higher levels of pain and disability.

Interdisciplinary spinal pain clinics in primary care: Outcomes from one service

BACKGROUND AND OBJECTIVES: Management of spinal pain in Australia is a common problem that often requires input from a range of health providers. Interdisciplinary care can be difficult to access, and care can easily become fragmented. A novel approach of setting up an interdisciplinary clinic in a primary care setting was analysed in this study. METHODS: Follow-up of patients 2­3 years after attending the clinic was undertaken. Specialist general practitioners (GPs) referring to the clinic were invited to give feedback. RESULTS: Forty-three patients participated in the study. Approximately half of patients reported clinically significant reductions in their overall pain and disability levels. GPs and participants broadly supported the clinic approach. DISCUSSION: Complex spinal pain interdisciplinary assessment in a primary care setting shows reasonable long-term outcomes comparable to more intensive interventions. Further exploration and fine-tuning of this model would seem a sensible option as current models of care are under strain.

Musculoskeletal pain - presentations to general practice.

BACKGROUND: In order to understand more about pain presentations in primary care, the authors undertook a descriptive study on musculoskeletal pain presentations to a general practice with a special interest in musculoskeletal medicine. The aim was to describe and categorise musculoskeletal pain presentations into pain subtypes. METHODS: Over a 5 week period in 2009, 133 consecutive musculoskeletal pain patients consented to participate in a study on pain presentations. Patients were categorised into: somatic, somatic referred, neuropathic or a combination of these. Further information was collected on age, gender, length of attendance, mode of referral, and current pain history. RESULTS: Patients were predominantly female with chronic pain problems. Somatic low back pain was the commonest pain presentation. Neuropathic pain was a feature of 25% of cases, with pure somatic referred pain presenting in 1 in 7 cases. Nearly half of the patients were referred by their usual general practitioner. DISCUSSION Differentiating pain types is important in pain management. Neuropathic and somatic referred pain are common presentations to primary practice but may be difficult to detect. Data on pain presentation subtypes in primary practice is important to inform medical educators and research organisations and instruct future planning for primary care.

Discrediting the notion "working with 'crazies' will make you 'crazy'": addressing stigma and enhancing empathy in medical student education.

People with mental illness around the world continue to suffer from stigmatization and limited care. Previous studies utilizing self-report questionnaires indicate that many medical students regard clinical work with psychiatric patients as unappealing, while the professionalism literature has documented a general decline in students' capacity for empathy over the course of medical school. Through in-depth interviews, this study attempts to better understand the formation of medical students' perceptions of psychiatry and the implications of that process for a more general understanding of the impact of emotionally-laden experiences on medical students' capacity for empathy. Forty-seven fourth-year medical students who had expressed interest or performed well in psychiatry were asked a series of questions to elicit their perceptions of the field of psychiatry. Interview transcripts were systematically coded using content analysis and principles of grounded theory. Stigma, stereotypes, and stressfully intense emotional reactions seemed to adversely affect the students' expected satisfaction from and willingness to care for the mentally ill, despite enjoying psychiatry's intellectual content and the opportunity to develop in-depth relationships with patients. Teaching faculty need to directly address the stigma and stereotypes that surround mental illness and actively help medical students cope with the stress that they report experiencing during their psychiatry clerkship in order to improve the recognition and treatment of psychiatric illness by newly graduating physicians. More generally, the relationships that we identify among stress, stigmatization, and stereotyping along an empathic spectrum suggest that increased attention should be paid to the stress that empathy can entail. This perspective may allow for the creation of similarly targeted interventions throughout the medical school curriculum to counteract the decline in empathy, the so-called "hardening of the heart," associated with physician-training worldwide.

Shoulder pain.

BACKGROUND: Shoulder pain is common in general practice and is a condition that frequently becomes chronic. Presentation includes either pain, weakness and stiffness, or a combination of these symptoms. OBJECTIVE: This article presents a systematic approach to diagnosing and managing disorders of the shoulder joint and surrounding structures. DISCUSSION: Thorough history taking (including psychosocial aspects) and skilled examination are essential; special investigations rarely affect the general practitioner's management of shoulder pain. The tendency toward chronicity of shoulder pain (increased by certain biological and psychosocial risks) means that the clinician should adopt a patient centred approach in choosing from a wide range of treatment modalities.

Acute shoulder pain in primary care - an observational study.

BACKGROUND: Shoulder pain is a common presentation in general practice. Data on prognosis, treatment and compliance for acute shoulder pain are lacking but would be valuable for guiding decision making. This study collected data on acute shoulder pain and its outcome over 6 months. METHODS: A prospective observational study of 100 acute shoulder pain patients from 21 general practices in southeast Queensland. RESULTS: Disability levels at presentation were the best predictor of outcome at 6 months. Patients who had not fully recovered at 6 months had higher risk of depression at presentation. The biggest improvements in pain and disability scores occurred in the first month of management, with almost 60% of patients fully recovered at 6 months. Over 40% of patients had at least one radiological investigation for their pain. DISCUSSION: Measuring disability, pain and mood levels in acute shoulder pain patients gives the best prognostic data. The use of radiological investigations may be higher than is clinically necessary. Early multimodal management of acute shoulder pain patients needs consideration.