Care pathways for patients with chronic musculoskeletal pain in general practice

Background and aims: The general practitioner (GP) is often the first-point of contact into the healthcare sector for patients with chronic musculoskeletal pain. The GP can refer patients towards additional diagnostic examinations and/or treatments in the secondary sector. The current care pathway is heterogenous and patients are in risk of receiving suboptimal care due to a fragmented and non-coherent care pathway. The objective was to investigate GP perspectives concerning challenges and possible solutions for the care pathways for chronic musculoskeletal pain patients.

Methods: We conducted a future workshop with 8 GPs to uncover current challenges and potentials for improving the care pathway. The workshop included a critiquing-, an ideation-, and an implementation phase. A case vignette and inspiration cards were designed and included to facilitate workshop discussions. Audio recordings were transcribed, and data was analyzed via thematic text analysis.

Results: The GPs highlighted patient’s expectations of anatomical explanations as challenging. Therefore, GPs were concerned that increased focus on psychosocial factors would make patients feel that their pain is not taken seriously. Proposed solutions were emphasis on pain management and early focus on biomedical and psychosocial factors. The GPs emphasize the need for a multidisciplinary examination to support patients. The GPs envisioned having the possibility to refer patients that does not respond to initiated treatments to a multidisciplinary setup, focusing on biopsychosocial factors.

Conclusions: It remains a challenge that patients focus on finding biomedical reasons for their chronic musculoskeletal pain. The GPs envisioned that a multidisciplinary setup, addressing the biopsychosocial factors could optimize future care pathways.