Opioids for chronic musculoskeletal pain

We are frequently quick to point the finger at extrinsic excuses for
our failings rather than addressing the fundamental intrinsic flaws that
underpin huge cracks in the delivery of modern medicine.

The proportion of consultations in primary care that are related to
musculoskeletal conditions ranges from approximately 18-35% [1]. If we
superimpose on top of this that musculoskeletal training at medical school
[2] and postgraduate levels almost certainly remains inadequate [3], is it
any surprise that musculoskeletal conditions are sub-optimally managed in
primary (and probably secondary) care?

It seems that there are two options: Firstly we need to address
doctors educational needs and ensure that musculoskeletal education has
the relative recognition in time, effort and expertise that is required to
serve patient needs in undergraduate and postgraduate education. Secondly,
if these educational needs continue to remain neglected despite repeated
calls for action, then it is high time that fundholders filled this gap
with the expertise of NHS employed Consultants in Sport & Exercise
Medicine, who are fully trained, unemployed and more than capable of
providing optimal non-surgical care for the vast majority of
musculoskeletal conditions (capable of saving the NHS millions on such
unnecessary drugs and referrals in the process!).

1 Jordan K, Clarke A, Symmons D, Fleming D, Porcheret M, Kadam U,
Croft P. Measuring disease prevalence: a comparison of musculoskeletal
disease using four general practice consultation databases. B J Gen Pr,
Volume 57, Number 534, January 2007 , pp. 7-14(8)

2 Woolf A, Walsh N, Akesson K. Global core recommendations for a
musculoskeletal undergraduate curriculum. Ann Rheum Dis. 2004 May; 63(5):
517�524.

3 Al-Nammari SS, James BK, Ramachandran M. The inadequacy of
musculoskeletal knowledge after foundation training in the United Kingdom.
J Bone Joint Surg Br. 2009 Nov;91(11):1413-8.

Competing interests:
None declared