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Cited by 216Musculoskeletal pain and rehabilitationPain Management and Opioid UsePain Management and Treatment

Identification and Management of Chronic Pain in Primary Care: a Review

Open access
Mills, Sarah, Torrance, Nicola, Smith, Blair H.·2016·Current Psychiatry Reports
DOI 10.1007/s11920-015-0659-9PMC PMC4731442
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Abstract

Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and re-assessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes identification and primary-care management of chronic pain, emphasizing biopsychosocial assessment, screening tools, and combined pharmacological and non-pharmacological care. It concludes that most chronic pain is managed in primary care but that high-quality primary-care-focused research remains limited.

Key findings

  • Chronic pain prevalence estimates range from 8–45% of the population, with 10–15% presenting to general practitioners; pain consultations account for 22% of all primary care consultations, and patients with chronic pain visit their GP twice as often as those without.
  • Comorbidity is common: 20–50% of chronic pain sufferers have co-morbid depression, 88% have other chronic illnesses (most commonly cardiovascular disease and depression), and severe chronic pain is associated with all-cause mortality, particularly cardiovascular death.
  • Screening/stratification tools include STaRT Back (nine questions; stratifies low/medium/high risk for progression from acute to chronic low back pain) and neuropathic pain tools (LANSS, DN4, NPQ, ID Pain, PainDETECT); brief interventions and pain biology education are under study.
  • Management aims at rehabilitation and quality of life; a 30–50% reduction in pain intensity is considered successful. Pharmacological care is stepped by pain type (e.g., paracetamol then tricyclic antidepressants, gabapentin, pregabalin for neuropathic pain; NSAIDs for nociceptive pain), with opioid caution (>120 mg/day morphine equivalent requires specialist supervision). Non-drug options include CBT, self-management, physiotherapy, TENS (70% benefited over 2 months; mean 9.8-point decrease on a 0–100 mm scale), pain management programmes, and telecare (doubled patients achieving >30% pain reduction, sustained at 12 months).

Methods

  • Design: narrative review of identification and management of chronic pain in primary care; no systematic search strategy, inclusion criteria, or formal quality appraisal is described.
  • Evidence base: synthesis of cited prevalence surveys, guidelines (SIGN, NICE, BPS, CPS, IASP/NeuPSIG), randomized trials, systematic reviews/meta-analyses, and emerging research on pharmacist roles, collaborative care, mindfulness, telecare, and decision-support tools.

Limitations

  • Stated: there is a relative lack of high-quality primary-care-focused research in chronic pain; further education, research, and resourcing are required.
  • Stated: access to pain management programmes is geographically restricted, limiting their utility in primary care; high comorbidity limits applicability of clinical guidelines to multimorbid patients and restricts treatment options.
  • Evident from text: as a narrative review, it does not report a systematic search or quality appraisal; some cited evidence is preliminary, small, or based on non-validated English versions of tools (e.g., DN4 and PainDETECT English versions not validated; EN-PNS initial trial had a small sample).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11920-015-0659-9

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 105 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Chronic pain is a common condition in primary care.

    “Chronic pain is a common condition in primary care and one that challenges both the distinction between mind and body and the concept of cure being the goal of medical intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] McQuay HJKE, Moore RA, editors. Epidemiology of chronic pain. Seattle: IASP Press; 2008.

      Not checked in the free run.

  • Premisecitation

    The most common comorbidities in patients with chronic pain were cardiovascular disease and depression.

    “The most common comorbidities were cardiovascular disease and depression.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

    • cites [13] Donaldson SL. 150 years of the Annual Report of the Chief Medical Officer: On the state of public health 2008. Department of Health, Richmond House, 79 Whitehall, London SW1A 2NJ, UK, dhmail@dh.gsi.gov.uk; 2009.

      Not checked in the free run.

    • cites [14•]

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  • Premisecitation

    Chronic pain is associated with significant increase in morbidity and mortality.

    “It is of great relevance to primary care that chronic pain is also associated with significant increase in morbidity and mortality [11, 12], with 20–50 % of chronic pain sufferers having co-morbid depression [9, 13, 14•].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. Eur J Pain. 2010;14(4):380–6. source

      Not checked in the free run.

    • cites [12] Mäntyselkä PT, Turunen JHO, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435. source

      Not checked in the free run.

  • Interpretationcitation

    Increasing the volume of patients managed in primary care could be a crucial step to delivering the coordinated and consistent care patients with chronic pain require.

    “Given that “the supply of pain specialists is exceeded greatly by the demand”[4] and that primary care represents a more cost-effective mechanism for healthcare delivery [7], increasing the volume of patients managed in primary care could be a crucial step to delivering the coordinated and consistent care patients with chronic pain require.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Acad Med J Assoc Am Med Coll. 2014;89(6):863–8. source

      Not checked in the free run.

    • cites [7] Davis K SK, Schoen C, Squires D. <Mirror, Mirror on the Wall. 2014 Update: How the U.S. Health Care System Compares Internationally - The Commonwealth Fund.pdf>. The Commonwealth Fund.

      Not checked in the free run.

  • Premisecitation

    Pain management risks being inconsistent and uncoordinated because of the relative newness of pain medicine as an independent subspecialty, multiple pain professional organizations, and increasing demands on the service.

    “Because of the relative newness of pain medicine as an independent subspecialty, the existence of multiple pain professional organizations and the increasing demands on the service, pain management risks are being inconsistent and uncoordinated [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Acad Med J Assoc Am Med Coll. 2014;89(6):863–8. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 38
  • May combine two claims. 25

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Addressing chronic pain in a general practice setting has the potential to deliver high-quality, readily accessible pain management available to the population in the volume required.

    “Addressing chronic pain in a general practice setting has the potential to be the solution to delivering high-quality, readily accessible pain management which is available to the population in the volume required; however, inherent to that solution are the challenges posed by identifying and managing chronic pain within the constraints of general/family practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most people who experience chronic pain live with it for at least 7 years.

    “The report “Pain in Europe” demonstrated that, most people who experience chronic pain live with it for at least 7 years and that one in six chronic pain sufferers say that their pain is sometimes so bad that they want to die [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Over 40% of chronic pain sufferers say their pain impacts on everyday activities.

    “Of participants surveyed, 27 % said that they were less able or unable to maintain relationships with friends and family and over 40 % of chronic pain sufferers say their pain impacts on everyday activities [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    It is estimated that 40-60% of patients with chronic pain have inadequate management of their pain.

    “It is estimated that 40–60 % of patients with chronic pain have inadequate management of their pain [9, 10].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In patients with chronic pain, 61% were less able or unable to work outside the home.

    “Breivik more recently demonstrated that, in patients with chronic pain, 21 % had been diagnosed with depression because of their pain, 61 % were less able or unable to work outside the home, 19 % had lost their job and 13 % had changed jobs because of their pain [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    27% of surveyed chronic pain sufferers said they were less able or unable to maintain relationships with friends and family.

    “Of participants surveyed, 27 % said that they were less able or unable to maintain relationships with friends and family and over 40 % of chronic pain sufferers say their pain impacts on everyday activities [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In patients with chronic pain, 21% had been diagnosed with depression because of their pain.

    “Breivik more recently demonstrated that, in patients with chronic pain, 21 % had been diagnosed with depression because of their pain, 61 % were less able or unable to work outside the home, 19 % had lost their job and 13 % had changed jobs because of their pain [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One in six chronic pain sufferers say that their pain is sometimes so bad that they want to die.

    “The report “Pain in Europe” demonstrated that, most people who experience chronic pain live with it for at least 7 years and that one in six chronic pain sufferers say that their pain is sometimes so bad that they want to die [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the USA, only 52% of patients with chronic pain are managed in primary care, with the rest relying on specialist care providers.

    “In the USA, only 52 % of patients with chronic pain are managed in primary care, with the rest relying on specialist care providers [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Dubois MY, Follett KA. Pain medicine: the case for an independent medical specialty and training programs. Acad Med J Assoc Am Med Coll. 2014;89(6):863–8. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Estimates of the population prevalence of chronic pain vary widely, with between 8 and 45% of the population reporting chronic pain and between 10 and 15% presenting to their general practitioner.

    “Estimates of the population prevalence of chronic pain vary widely, with between 8 and 45 % of the population reporting chronic pain, and between 10 and 15 % of the population presenting to their general practitioner (GP) [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] McQuay HJKE, Moore RA, editors. Epidemiology of chronic pain. Seattle: IASP Press; 2008.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In patients with chronic pain, 13% had changed jobs because of their pain.

    “Breivik more recently demonstrated that, in patients with chronic pain, 21 % had been diagnosed with depression because of their pain, 61 % were less able or unable to work outside the home, 19 % had lost their job and 13 % had changed jobs because of their pain [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Chronic pain has wide-reaching personal, social and psychological impacts, as well as national economic consequences.

    “Chronic pain has wide-reaching personal, social and psychological impacts, as well as national economic consequences.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In patients with chronic pain, 19% had lost their job.

    “Breivik more recently demonstrated that, in patients with chronic pain, 21 % had been diagnosed with depression because of their pain, 61 % were less able or unable to work outside the home, 19 % had lost their job and 13 % had changed jobs because of their pain [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An overall reduction of pain intensity by 30-50% is formally considered to be a successful outcome, as is an overall improvement in quality of life.

    “An overall reduction of pain intensity by 30–50 % is formally considered to be a successful outcome, as is an overall improvement in quality of life [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Almost half of all people with chronic pain were taking non-prescription analgesics, including NSAIDs (55%), paracetamol (43%) and weak opioids (13%).

    “In their large-scale study of chronic pain, Breivik found that almost half of all people with chronic pain were taking non-prescription analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) (55 %), paracetamol (acetaminophen) (43 %) and weak opioids (13 %).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Achieving complete freedom from pain is an unusual outcome.

    “It should be made clear to patients that achieving complete freedom from pain is an unusual outcome.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    When treatments have been tried at the onset of chronic pain, patients may consider them not to have worked because they did not cure the pain; however, with the continuation of chronic pain and the shifting of treatment aims from cure to management, patients may find previously discounted treatments of benefit.

    “Particularly, when treatments have been tried at the onset of chronic pain, patients may consider them not to have worked because they did not cure the pain; however, with the continuation of chronic pain and the shifting of treatment aims from cure to management, patients may find previously discounted treatments of benefit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    For any advances in identification and management of chronic pain to be useful in a primary care setting, they must be useable within the time and resource constraints and restrictions that are inherent to general practice.

    “For any advances in identification and management of chronic pain to be useful in a primary care setting, they must be useable within the time and resource constraints and restrictions that are inherent to general practice.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: GPs see undifferentiated illness in patients whom they assess, diagnose and manage in the space of a 10-minute appointment.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    In assessing patients with chronic pain, physicians should view chronic pain as a serious risk marker for premature mortality.

    “Such evidence suggests that in assessing patients with chronic pain, physicians should view chronic pain as a serious risk marker for premature mortality [11, 14•].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. Eur J Pain. 2010;14(4):380–6. source

      Not checked in the free run.

    • cites [14•]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    In managing patients with chronic pain in primary care, the aim is generally to rule out treatable and modifiable causes and then support the patient to live as well as possible, with the maximum quality of life in spite of their chronic pain.

    “In managing patients with chronic pain in primary care, the aim is generally to rule out treatable and modifiable causes and then support the patient to live as well as possible, with the maximum quality of life in spite of their chronic pain.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    These developments have the potential to aid GPs in identifying patients at risk of chronic pain and in successfully targeting early interventions aimed at reducing progression to severe chronic pain.

    “These developments have the potential not only to aid GPs in identifying patients at risk of chronic pain but also in successfully targeting early interventions aimed at reducing progression to severe chronic pain.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Assessment and re-assessment are essential in all stages of managing chronic pain.

    “Assessment and re-assessment are essential in all stages of managing chronic pain, and it is important to ensure that any new treatment is given a full and proper trial, so that potentially effective treatments are often not discarded because of an incomplete trial of treatment, inappropriate timing or dose of drugs, poor medication compliance and/or mismatched patient expectations [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Fam Pract. 1999;16(5):475–82. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Severe chronic pain is significantly associated with all-cause mortality and particularly death from cardiovascular disease.

    “Torrance et al. established that severe chronic pain was significantly associated with all-cause mortality and particularly death from cardiovascular disease [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. Eur J Pain. 2010;14(4):380–6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with chronic pain visit their GP twice as often as patients without chronic pain.

    “Patients with chronic pain visit their GP twice as often as patients without chronic pain [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Andersson HIEG, Leden I, Schersten B. Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study. J Epidemiol Community Health. 1999;53(8):503–9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A number of recent comprehensive guidelines focus on the management of chronic pain and are relevant to primary care.

    “A number of recent comprehensive guidelines focus on the management of chronic pain and are relevant to primary care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The STaRT Back Tool was developed in UK primary care and is designed to help physicians in the assessment of patients at risk of progressing from acute to chronic low back pain.

    “The STaRT Back Tool was developed in UK primary care and is designed to help physicians in the assessment of patients at risk of progressing from acute to chronic low back pain (LBP) [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Beneciuk JM, Bishop MD, Fritz JM, Robinson ME, Asal NR, Nisenzon AN, et al. The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther. 2013;93(3):321. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pain is one of the main reasons for patients seeking contact with healthcare.

    “Consultations on pain account for 22 % of all primary care consultations [12], and pain is one of the main reasons for patients seeking contact with healthcare [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Briggs EV, Carr ECJ, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15(8):789–95. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Any new treatment should be given a full and proper trial so that potentially effective treatments are not discarded because of an incomplete trial of treatment, inappropriate timing or dose of drugs, poor medication compliance and/or mismatched patient expectations.

    “Assessment and re-assessment are essential in all stages of managing chronic pain, and it is important to ensure that any new treatment is given a full and proper trial, so that potentially effective treatments are often not discarded because of an incomplete trial of treatment, inappropriate timing or dose of drugs, poor medication compliance and/or mismatched patient expectations [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Fam Pract. 1999;16(5):475–82. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In most countries, of the 20% of the general population who experience chronic pain, the overwhelming majority are managed in primary care by their family doctor, while only 0.5-2% are ever referred to secondary care for pain management.

    “In most countries, of the 20 % of the general population who experience chronic pain, the overwhelming majority are managed in primary care by their family doctor (general practitioner, GP), while only 0.5–2 % [9] are ever referred to secondary care for pain management.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The STaRT Back Tool stratifies patients into low, medium and high risk and recommends appropriate treatment for each patient based on their risk level.

    “It stratifies patients into low, medium and high risk and recommends appropriate treatment for each patient based on their risk level [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Beneciuk JM, Bishop MD, Fritz JM, Robinson ME, Asal NR, Nisenzon AN, et al. The STarT back screening tool and individual psychological measures: evaluation of prognostic capabilities for low back pain clinical outcomes in outpatient physical therapy settings. Phys Ther. 2013;93(3):321. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The high prevalence of comorbidities in patients with chronic pain can limit the applicability and utility of clinical guidelines to multimorbid patients with chronic pain and restrict what treatment options can be used in pain control.

    “This high prevalence of comorbidities in patients with chronic pain can limit the applicability and utility of clinical guidelines to multimorbid patients with chronic pain [15] and restrict what treatment options can be used in pain control.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Guthrie B, Payne K, Alderson P, McMurdo MET, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. Br Med J. 2012;345:5. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Consultations on pain account for 22% of all primary care consultations.

    “Consultations on pain account for 22 % of all primary care consultations [12], and pain is one of the main reasons for patients seeking contact with healthcare [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Mäntyselkä PT, Turunen JHO, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    The SIGN Guideline is a particularly robust tool for primary care physicians.

    “The SIGN Guideline is a particularly robust tool for primary care physicians; a summary of its recommendations is in Table 2 [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Smith BHHJ, Stein A, Colvin L. Managing chronic pain in the non-specialist setting: a new SIGN guideline. Br J Gen Pract. 2014;64(624):e462–e4. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    The successful management of chronic pain in primary care relies on a multidisciplinary and holistic approach aimed at both minimizing pain as much as possible and teaching patients how to live well with chronic pain.

    “The successful management of chronic pain in primary care relies on a multidisciplinary and holistic approach aimed at both minimizing pain as much as possible and teaching patients how to live well with chronic pain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One third of chronic pain sufferers were not currently using any treatment.

    “Breivik’s evaluation of patients with chronic pain demonstrated that one third of chronic pain sufferers were not currently using any treatment and that two thirds were using non-medication treatments, including massage (30 %), physical therapy (21 %) and acupuncture (13 %) [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Recent studies call into question the good tolerability and efficacy of paracetamol, and circumspection is needed about even this basic treatment.

    “However, recent studies call this into question, and we need a degree of circumspection about even this basic treatment [16, 43].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [16] Butchart A, Kerr EA, Heisler M, Piette JD, Krein SL. Experience and management of chronic pain among patients with other complex chronic conditions. Clin J Pain. 2009;25(4):293–8. source

      Not checked in the free run.

    • cites [43] Bennett MI, Smith BH, Torrance N, Lee AJ. Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians. Pain. 2006;122(3):289–94. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Levels of patient satisfaction were higher in the group using CAM.

    “One recent survey demonstrated that over 70 % of patients with chronic pain had used complementary therapies and that levels of patient satisfaction were higher in the group using CAM [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Pannek J, Pannek-Rademacher S, Wollner J. Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study. Spinal Cord. 2015;53(7):569–72. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Topical NSAIDs, such as ibuprofen gel, can be used effectively in many causes of chronic pain and have better safety than oral NSAIDs and comparable efficacy.

    “Topical NSAIDs, such as ibuprofen gel, can be used effectively in many causes of chronic pain and have better safety than oral NSAIDs and comparable efficacy; however, current evidence does not support their use in back pain [46].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Haroutiunian S, Drennan DA, Lipman AG. Topical NSAID therapy for musculoskeletal pain. Pain Med. 2010;11(4):535–49. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two thirds of people with chronic pain were taking prescription medicines, including NSAIDs (44%), weak opioids (23%), paracetamol (18%), COX-2 inhibitors (1-36%) and strong opioids (5%).

    “Two thirds were taking prescription medicines, including NSAIDs (44 %), weak opioids (23 %), paracetamol (acetaminophen) (18 %), COX-2 inhibitors (1–36 %) and strong opioids (5 %) [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Breivik H. A major challenge for a generous welfare system: a heavy socio-economic burden of chronic pain conditions in Sweden—and how to meet this challenge. Eur J Pain (Lond Engl). 2012;16(2):167. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The complementary therapies most commonly used for chronic pain are osteopathy, chiropractic, homeopathy, acupuncture and herbalism, and rarely hypnosis and aromatherapy.

    “The complementary therapies most commonly used for chronic pain are osteopathy, chiropractic, homeopathy, acupuncture and herbalism (and rarely hypnosis and aromatherapy) [58, 59].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [58] Haetzman M, Elliott AM, Smith BH, Hannaford P, Chambers WA. Chronic pain and the use of conventional and alternative therapy. Fam Pract. 2003;20(2):147–54. source

      Not checked in the free run.

    • cites [59] Cosio D, Lin EH. Effects of a pain education program in complementary and alternative medicine treatment utilization at a VA medical center. Complement Ther Med. 2015;23(3):413–22. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    While pain type is broadly either nociceptive or neuropathic, many pains are mixed, requiring multi-modal pharmacology.

    “While pain type is broadly either nociceptive or neuropathic, many pains are mixed, requiring multi-modal pharmacology [43].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Bennett MI, Smith BH, Torrance N, Lee AJ. Can pain can be more or less neuropathic? Comparison of symptom assessment tools with ratings of certainty by clinicians. Pain. 2006;122(3):289–94. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physiotherapy has a beneficial effect on pain intensity and physical function for musculoskeletal pain.

    “For musculoskeletal pain, current research confirms the beneficial effect of physiotherapy on both pain intensity and on physical function [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Magalhaes MO, Muzi LH, Comachio J, Burke TN, Franca FJR, Ramos LAV, et al. The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: a randomized controlled trial. Man Ther. 2015;20(4):603–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent Cochrane review of 35 trials examining psychological approaches to chronic pain management found that behaviour therapy produced small short-lived benefits, but that patients who had CBT showed improvements in pain, as well as in disability, mood and catastrophic thinking.

    “A recent Cochrane review of 35 trials examining psychological approaches to chronic pain management found that behaviour therapy produced small short-lived benefits, but that patients who had CBT showed improvements in pain, as well as in disability, mood and catastrophic thinking [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11:CD007407.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Initial clinical trial results indicate the potential for huge benefit for external noninvasive peripheral nerve stimulation (EN-PNS), though the sample size was small.

    “Initial clinical trial results indicate the potential for huge benefit, though the sample size was small [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Johnson S, Ayling H, Sharma M, Goebel A. External noninvasive peripheral nerve stimulation treatment of neuropathic pain: a prospective audit. Neuromodulation. 2015;18(5):384–91. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Self-management is effective and potentially cost-effective in improving pain among an older adult population.

    “Boyers et al. determined that self-management is effective and potentially cost-effective in improving pain among an older adult population, though noted that further research was required [52].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Boyers D, McNamee P, Clarke A, Jones D, Martin D, Schofield P, et al. Cost-effectiveness of self-management methods for the treatment of chronic pain in an aging adult population a systematic review of the literature. Clin J Pain. 2013;29(4):366–75. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Most patients using alternative medicine do so in conjunction with conventional healthcare.

    “Most patients using alternative medicine do so in conjunction with conventional healthcare [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Haetzman M, Elliott AM, Smith BH, Hannaford P, Chambers WA. Chronic pain and the use of conventional and alternative therapy. Fam Pract. 2003;20(2):147–54. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Over 70% of patients with chronic pain had used complementary therapies.

    “One recent survey demonstrated that over 70 % of patients with chronic pain had used complementary therapies and that levels of patient satisfaction were higher in the group using CAM [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Pannek J, Pannek-Rademacher S, Wollner J. Use of complementary and alternative medicine in persons with spinal cord injury in Switzerland: a survey study. Spinal Cord. 2015;53(7):569–72. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Participants who received CBT had improved measures of disability, reduced pain intensity, reduced depression and better quality of life 1 year after intervention than those receiving standard care.

    “Participants who received CBT had improved measures of disability, reduced pain intensity, reduced depression and better quality of life 1 year after intervention than those receiving standard care [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, et al. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet. 2010;375(9718):916–23. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Current research suggests that inappropriate NSAID prescribing is common and needs to be addressed urgently to improve patient safety.

    “Current research suggests that inappropriate NSAID prescribing is common and needs to be addressed urgently to improve patient safety [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Ussai S, Miceli L, Pisa FE, Bednarova R, Giordano A, Della Rocca G, et al. Impact of potential inappropriate NSAIDs use in chronic pain. Drug des Dev Ther. 2015;9:2073–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A meta-analysis demonstrated only limited evidence in support of mindfulness-based interventions for patients with chronic pain.

    “In spite of a number of recent studies in this area, however, in their meta-analysis, Bawa et al. demonstrated only limited evidence in support of mindfulness-based interventions for patients with chronic pain and called for more and better studies in this area [70, 71].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [70] Bawa FL, Mercer SW, Atherton RJ, Clague F, Keen A, Scott NW, et al. Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract J R Coll Gen Pract. 2015;65(635):e387–400. source

      Not checked in the free run.

    • cites [71] Toye F, Andrews J, Barker K, Seers K, Allcock N, Briggs M, et al. Patients' experiences of chronic non-malignant musculoskeletal pain: a qualitative systematic review. Br J Gen Pract. 2013;63(617):e829–e41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    There continues to be a relative lack of high-quality primary-care-focused research in chronic pain.

    “However, there continues to be a relative lack of high-quality primary-care-focused research in chronic pain.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The use of telecare in patients with chronic pain is growing an evidence base suggesting it is beneficial in chronic pain management.

    “The use of telecare in patients with chronic pain is growing an evidence base suggesting it is beneficial in chronic pain management.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Mindfulness Based Functional Therapy (MBFT) in primary care showed good patient adherence and satisfaction among people with chronic low back pain.

    “In their study of Mindfulness Based Functional Therapy (MBFT) in primary care, Schutze et al. showed good patient adherence and satisfaction, reduced pain catastrophising and improved physical functioning among people with chronic LBP [69].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [69] Schutze R, Slater H, O'Sullivan P, Thornton J, Finlay-Jones A, Rees CS. Mindfulness-based functional therapy: a preliminary open trial of an integrated model of care for people with persistent low back pain. Front Psychol. 2014;5:839.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Recent high-quality guidelines are available for chronic pain management.

    “Recent high-quality guidelines are available, and some trials show encouraging results for the application of pharmacological and non-pharmacological interventions in the holistic management of patients with chronic pain.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The BPS guidelines advocate the use of PMPs, based on cognitive behavioral principles, as the treatment of choice for people with persistent pain with biopsychosocial dysfunction.

    “In their new guidelines, the BPS advocates the use of PMPs, based on cognitive behavioral principles, as the treatment of choice for people with persistent pain with biopsychosocial dysfunction [63].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Society TBP, editor. Guidelines for pain management programmes for adults. London: The British Pain Society; 2013.

      Not checked in the free run.

55 of 55

  • The paper relies on this without support.

    GPs see undifferentiated illness in patients whom they assess, diagnose and manage in the space of a 10-minute appointment.

    “GPs see undifferentiated illness in patients whom they assess, diagnose and manage in the space of a 10-minute appointment.”

  • The paper relies on this without support.

    The vast majority of patients with chronic pain are managed in primary care.

    “Given the frequency of chronic pain as a presentation in primary care, and that the vast majority of patients with chronic pain are managed in primary care, GPs should have adequate evidence, training and resources to assess and manage chronic pain.”

  • The paper relies on this without support.

    Access to PMPs is geographically restricted, limiting their utility in primary care pain management.

    “However, in practice, access to PMPs is geographically restricted, limiting their utility in primary care pain management.”

  • The paper relies on this without support.

    Chronic pain is a frequent presentation in primary care.

    “Given the frequency of chronic pain as a presentation in primary care, and that the vast majority of patients with chronic pain are managed in primary care, GPs should have adequate evidence, training and resources to assess and manage chronic pain.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting year for the cited NICE low-back-pain guideline

    Minor

    The text calls the cited NICE low-back-pain guideline a 2010 guideline, but reference 60 lists it as 2009.

1 of 1

Cites

Flagged first, then by citations

2 of the 65 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. McQuay HJKE, Moore RA, editors. Epidemiology of chronic pain. Seattle: IASP Press; 2008.
  2. Cameron PSC. The need to define chronic pain self-management. J Pain Manag. 2012;5(3):231–6.
  3. Society TBP, editor. Guidelines for pain management programmes for adults. London: The British Pain Society; 2013.
  4. Smith BH, Hardman JD, Stein A, Colvin L. Managing chronic pain in the non- specialist setting: a new SIGN guideline. Br J Gen Pract. 2014;64(624):e462–e4. · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Mills, S., Torrance, N., & Smith, B. H.
Affiliations
University of Dundee (GB)
Corresponding author
Mills, Sarah
ORCID
Venue
Current Psychiatry Reports
Publisher
Springer Science and Business Media LLC
Published
2016-01-28
Volume
18
Issue
2
Pages
22-22
ISSN
  • 1523-3812 (ISSN-L)
  • 1535-1645
DOI
10.1007/s11920-015-0659-9
PMC
PMC4731442
OpenAlex
W2281303539
Semantic Scholar
358537af9346945280992636e69b473f156b18c8
Cited by
216
References
65
Citations by year
2026: 17 · 2025: 28 · 2024: 37 · 2023: 24 · 2022: 15 · 2021: 27 · 2020: 29 · 2019: 14 · 2018: 11 · 2017: 9 · 2016: 4
FWCI
1.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Psychiatry Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
  • Open Access Institutional Repository at Robert Gordon University (Robert Gordon University) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic pain, primary care, pain screening, brief intervention, acute pain, rehabilitation, quality of life, pharmacotherapy, non-pharmacological treatment, self-management, physiotherapy, peripheral nerve stimulation, complementary therapy, holistic care, specialist referral
MeSH terms
Mental Disorders, Humans, Physical Examination, Primary Health Care, Quality of Life, Self Care, Disease Management, Chronic Pain

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

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