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Treatment of Chronic Musculoskeletal Back Pain in a Tertiary Care Pain Clinic

Objectives There are insufficient data about range and efficacy of treatments provided to patients with musculoskeletal back pain in tertiary pain clinics. We aimed to analyze the number of patients visiting a tertiary pain clinic due to chronic musculoskeletal back pain, the treatments prescribed to these patients in a pain clinic, and any reduction of pain intensity that patients report following the treatment. Methods Retrospective study of patients treated for chronic musculoskeletal back pain from 2006 to 2009 was conducted at a tertiary Pain Clinic of University Hospital Split in Croatia. We studied the number of patients, their medical documentation, prescribed therapy and their pain intensity determined by visual analog scale during the first visit and a follow-up visit. Results Patients with chronic musculoskeletal back pain represented 78 percent of all patients and 80 percent of all visits in the pain clinic. The majority of patients were women with a median age of 58 years. Patients were prescribed opioid and non-opioid drugs, transcutaneous electrical nerve stimulation, magnetic therapy, ultrasound and laser therapy, either as a single intervention , or in various combinations. Tramadol and combination of tramadol and paracetamol were the most commonly prescribed drugs. In all patients groups, the reduction of pain intensity on a control visit was about 30 percent; there was no significant difference between groups. Conclusions Chronic musculoskeletal back pain is the major reason why patients visit pain clinics. Efficacy of various pharmacological and non-pharmacological treatments offered at pain clinics was not significantly different. Introduction of a bio-psychosocial approach to treatment of chronic pain is recommended.