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Widespread musculoskeletal pain

Patients go to their GP with symptoms rather than diseases, and often it takes time for musculoskeletal problems to evolve into a recognisable form. GPs have the challenge to manage this uncertainty in a safe and balanced way, using resources appropriately.

There are over 100,000 GP consultations in the UK each year for musculoskeletal problems. Only a small proportion of these will be related to inflammatory types of arthritis. However, it's important that patients with inflammatory arthritis are identified at an early stage so that they can receive disease-modifying therapy with significant prognostic benefits.

Learning objectives

This module will help you to:

  • understand the key features that differentiate between inflammatory and non-inflammatory causes of musculoskeletal pain
  • recognise red flag symptoms
  • make appropriate use of investigations to help with making a diagnosis
  • agree a management plan with the patient including referral as appropriate.
a medical professional with a patient

Causes of musculoskeletal pain

Musculoskeletal pain can have many causes and diagnosing a patient can be complicated by coexisting conditions.

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Lady holding sore neck

Taking a patient history

A detailed history provides important clues when deciding whether musculoskeletal pain has an inflammatory cause.

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man and a physiotherapist

Examination for musculoskeletal pain

Patients expect a physical examination and it provides crucial information about where the pain is coming from.

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Man having an injection in his arm

Investigations for musculoskeletal pain

Investigations can be most useful to maximise the benefit of the patient's first outpatient appointment and to add certainty to a case that you think is non-inflammatory or manageable in primary care.

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GP talking to patient


Weighing up the likely causes of a patient's pain is key to deciding on an initial management plan and in considering whether to refer for specialist opinion.

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Lady having chat with doctor

Referral and further action

Referral to secondary care may be required for diagnosis and/or treatment and may be appropriate even where a condition can normally be managed in primary care.

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Lady talking with GP

Summary and further reading

Reaching a diagnosis is a matter of piecing together clues from the history and examination, while appropriate investigations may be used to support or exclude a specific diagnosis.

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Lady holding a sore shoulder

Case studies

These case studies offer examples of how the principles of assessing widespread musculoskeletal pain might be applied in everyday practice.

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