Re: Diagnosis first, treatment second; Patterns of pain
I agree with Gavin Tait. Without proper diagnosis, treatment regimes
are more likely to be ineffective, i.e. we end up with Voltaire's
principle of simply entertaining the patient whilst nature takes its
course (for better or for worse).
Diagnostic triage for shoulder pain depends on the ability of the
clinician to accurately identify diagnostic sub-groups. The authors
suggest that this should be straight forward. However, the diagnostic
triage system for low back pain advocated some years ago by CSAG and the
RCGP does not appear to have improved back pain management in this
country.
This may be due to a failure of clinicians to adopt the principles of
diagnostic triage and acquire the skills to carry it out effectively. It
may also reflect that determination of many health care practitioners to
pursue evidence-weak treatments at all cost, simply to justify their
involvement in the care of the patient.
Acupuncture may have a role in the management of shoulder pain, but
the evidence for its use is weak. This does preclude its use, but it does
require the clinician to justify any treatment protocol on the basis of
accurate diagnosis and sound clinical reasoning.
Competing interests:
Member of Acupuncture Association of Chartered Physiotherapists
Rapid Response:
Re: Diagnosis first, treatment second; Patterns of pain
I agree with Gavin Tait. Without proper diagnosis, treatment regimes
are more likely to be ineffective, i.e. we end up with Voltaire's
principle of simply entertaining the patient whilst nature takes its
course (for better or for worse).
Diagnostic triage for shoulder pain depends on the ability of the
clinician to accurately identify diagnostic sub-groups. The authors
suggest that this should be straight forward. However, the diagnostic
triage system for low back pain advocated some years ago by CSAG and the
RCGP does not appear to have improved back pain management in this
country.
This may be due to a failure of clinicians to adopt the principles of
diagnostic triage and acquire the skills to carry it out effectively. It
may also reflect that determination of many health care practitioners to
pursue evidence-weak treatments at all cost, simply to justify their
involvement in the care of the patient.
Acupuncture may have a role in the management of shoulder pain, but
the evidence for its use is weak. This does preclude its use, but it does
require the clinician to justify any treatment protocol on the basis of
accurate diagnosis and sound clinical reasoning.
Competing interests:
Member of Acupuncture Association of Chartered Physiotherapists
Competing interests: No competing interests