Public health

Waves of change with more bone and joint pain

The international tsunami of musculoskeletal pain has already arrived and will force change in the way clinicians and the community respond to inflammatory and non-inflammatory disorders.

Speaking in the opening session of the 5th World Congress on Controversies, Debates & Consensus in Bone, Muscle & Joint Diseases, Professor Kevin Pile said musculoskeletal disorders were already the major cause of years lived with disability.

Lower back and neck pain was the leading cause of disability globally, in all high-income countries and in most other countries.

Professor Pile, director of medicine at Campbelltown Hospital and past president of the Asia Pacific League for Associations of Rheumatology, said the trends were concerning.

“The global prevalence of low back pain has increased by 17% between 2005 and 2015 and osteoarthritis by 33% over that decade, and there is no reason to suspect that isn’t going to continue.”

He said countries such as India were transitioning from a focus on communicable diseases, now being treated very effectively, to significant chronic problems such as musculoskeletal pain.

“The world is getting bigger, the population is getting heavier and it’s also getting older.”

Professor Pile said age and obesity were both pro-inflammatory states and rheumatologists were going to have to focus on conditions such as rheumatoid arthritis, psoriatic arthritis, lupus and gout.

“I think most of us already have enough business and the tsunami will focus rheumatologists primarily on what the GP and others can’t do, which is inflammatory joint disease.”

In order to ensure conditions such as low back pain, osteoarthritis and osteoporosis weren’t neglected, there had to be more advocacy for primary prevention, community education to encourage self-management, and up-skilling of GPs.

Professor Pile said better use of a multidisciplinary team was also critical.

“A number of Primary Health Networks have started to create and encourage such a team approach but they are too few.”

He said they needed to address psychological drivers of pain and obesity, focus on increasing self-reliance, and involve exercise physiologists and dietetic input.

“Many people think the only way to exercise is by using their legs. There are skilled exercise physiologists who can show what to do with arms alone or how to exercise your legs without making joint pain worse.”

“Patients might just need walking aids, weight reduction, physiotherapy and an explanation of what is going on.”

Professor Pile emphasised that people’s experience of pain was partly determined by culture and expectations.

“You do get these discrepancies. For example, 15% of manual workers in India describe pain compared to 37% of office workers in the UK.”

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