Predict shoulder pain outcomes

GPs can now calculate the expected long-term outcome of patients' shoulder pain using clinical prediction rules devised by Dutch researchers.

The rules are based on an analysis of 587 patients who presented with shoulder pain.

The patients underwent a physical examination that recorded the mobility and pain felt in the shoulder and neck. They also filled in questionnaires that recorded information about their symptoms, physical leisure and work activity, and psychological and social factors.

Patients were then given the usual stepwise treatment consisting of paracetamol, NSAIDs, corticosteroid injections or referral for physiotherapy.

Patient outcomes were recorded at six weeks and six months, by which point 30 per cent and 54 per cent of participants had recovered.

The researchers then worked out which factors presented at the first consultation could predict the patients who would still be in pain much later. They used the results to draw up score charts for predicting pain after six weeks or six months.

Each chart gives a weighting to the relevant factors at presentation, so that a score can be generated for each patient.

The researchers suggest GPs use the score charts to predict the risk of persistent symptoms.

Pain 2006; 120: 276-85


Factors for pain at six weeks

- Gradual onset.

- Repetitive movements.

- Psychological problems.

- Neck pain.

Factors for pain at six months

- Gradual onset.

- Lower back pain.

- High pain at baseline.

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