Patient Willingness to Use Nonpharmacologic Approaches to Manage Musculoskeletal Pain

Most patients presenting to the emergency department (ED) with musculoskeletal pain were found to be willing to try nonpharmacologic treatments for pain management, according to results of a study published in Pain Reports.

Adult patients (N=206) who presented to the ED affiliated with Duke School of Medicine in the United States between 2018 and 2019 for treatment of musculoskeletal pain were recruited for this study. Demographic information and clinical characteristics were recorded, and the patients were asked whether they would be willing to try or had tried nonpharmacologic approaches for pain management.

The mean age of the study participants was 45.4 (standard deviation [SD], 16.4) years. The most common pain location was the leg (40.7%), median Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity score was 7 (interquartile range [IQR], 5-9), median PROMIS pain interference score was 65.1 (IQR, 55.7-71.3), and median PROMIS physical function score was 32.3 (IQR, 27.5-38.9).

Most patients indicated they were willing to try a nonpharmacologic pain treatment (90.3%), with approximately one-half having already tried at least 1 nonpharmacologic modality.

Patients were most willing to try using a cold pack (61.7%), heat (59.7%), physical therapy (59.2%), massage (52.4%), and prayer (46.1%). The patients were least likely to be willing to try a support group (17.5%), acupuncture (18.9%), or yoga (19.4%). The most endorsed previously attempted approaches were cold pack (36.4%), heat (36.4%), and prayer (25.2%).

Willingness to try active treatments was significantly associated with having no access to primary care (odds ratio [OR], >999.999), upper back pain (OR, 5.466), and multiple pain locations (OR, 2.264), as well as experiencing activity limitations (OR, 2.172) and having the goal to do more everyday household or yard activities (OR, 1.464). Willingness to try passive approaches was associated with being a college graduate (OR, 4.329), having no previous pain (OR, 2.833), experiencing traumatic pain onset (OR, 2.757), married status (OR, 2.377), having leg pain (OR, 1.887), and having a goal of pain relief (OR, 1.383). Patients who had upper back pain (OR, >999.999), Medicare insurance (OR, 3.637), multiple pain locations (OR, 2.792), some college education (OR, 2.408), and had not visited other health care providers for pain in the previous year (OR, 1.376) were found to be willing to try psychosocial interventions.

Patients who were sometimes or often encouraged by a physician or nurse to use nonpharmacologic treatments for pain were more likely to have previously attempted using such methods (OR range, 1.779-6.699).

Researchers concluded that most patients presenting to the ED with musculoskeletal pain were willing to try nonpharmacologic pain relief strategies. In addition, more patients who had previously attempted using nonpharmacologic approaches had been encouraged to do so by health care professionals. The investigators commented that “[t]hese findings are encouraging because they align with recent practice guidelines to increase the use of nonpharmacologic pain management strategies from the ED.”