The DOI matches its Crossref record; 63 of the 65 references it cites were found in a registry or an index; none of the 105 sources its claims cite is checked for support yet.
Identification and Management of Chronic Pain in Primary Care: a Review
Open accessAbstract
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.
Overview
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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).
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Claims the paper makes
90 Not checked yet · 11 Own interpretation · 2 No basis given
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [3] McQuay HJKE, Moore RA, editors. Epidemiology of chronic pain. Seattle: IASP Press; 2008.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“The most common comorbidities were cardiovascular disease and depression.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [14•]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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•].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [12] Mäntyselkä PT, Turunen JHO, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“In an important study on multimorbidity, Barnett et al. established that chronic pain is one of the commonest morbidities to co-occur with other long-term conditions, but also that 88 % of patients with chronic pain have other chronic illnesses [9, 13, 14•].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [14•]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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•].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [14•]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“In an important study on multimorbidity, Barnett et al. established that chronic pain is one of the commonest morbidities to co-occur with other long-term conditions, but also that 88 % of patients with chronic pain have other chronic illnesses [9, 13, 14•].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [14•]
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“New research suggests that a model of brief intervention, in which clinicians give involved feedback on behaviour and how to reduce pain-generating behaviour, is successful in reducing chronic pain from medication overuse headaches [30].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [30] Kristoffersen ES, Straand J, Vetvik KG, Benth JS, Russell MB, Lundqvist C. Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. J Neurol Neurosurg Psychiatry. 2015;86(5):505–12. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Some screening tools for specific kinds of chronic pain have been shown to be effective in primary care.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 38
- It may state two separate claims as one. 25
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“It is estimated that 40–60 % of patients with chronic pain have inadequate management of their pain [9, 10].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In the USA, only 52 % of patients with chronic pain are managed in primary care, with the rest relying on specialist care providers [4].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [3] McQuay HJKE, Moore RA, editors. Epidemiology of chronic pain. Seattle: IASP Press; 2008.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Chronic pain has wide-reaching personal, social and psychological impacts, as well as national economic consequences.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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 %).”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It should be made clear to patients that achieving complete freedom from pain is an unusual outcome.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
- Rests on an assumption: GPs see undifferentiated illness in patients whom they assess, diagnose and manage in the space of a 10-minute appointment.
None of the sources cited for this claim have been checked yet.
In the paper
“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•].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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 yetcites [14•]
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [31] Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Fam Pract. 1999;16(5):475–82. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Torrance et al. established that severe chronic pain was significantly associated with all-cause mortality and particularly death from cardiovascular disease [11].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Patients with chronic pain visit their GP twice as often as patients without chronic pain [19].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“A number of recent comprehensive guidelines focus on the management of chronic pain and are relevant to primary care.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [31] Smith BH, Hopton JL, Chambers WA. Chronic pain in primary care. Fam Pract. 1999;16(5):475–82. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It stratifies patients into low, medium and high risk and recommends appropriate treatment for each patient based on their risk level [25].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Identification of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
What the sources say
- Not checked yetcites [12] Mäntyselkä PT, Turunen JHO, Ahonen RS, Kumpusalo EA. Chronic pain and poor self-rated health. JAMA. 2003;290(18):2435. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The SIGN Guideline is a particularly robust tool for primary care physicians; a summary of its recommendations is in Table 2 [41].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“However, recent studies call this into question, and we need a degree of circumspection about even this basic treatment [16, 43].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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 yetcites [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
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [46] Haroutiunian S, Drennan DA, Lipman AG. Topical NSAID therapy for musculoskeletal pain. Pain Med. 2010;11(4):535–49. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The complementary therapies most commonly used for chronic pain are osteopathy, chiropractic, homeopathy, acupuncture and herbalism (and rarely hypnosis and aromatherapy) [58, 59].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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 yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“While pain type is broadly either nociceptive or neuropathic, many pains are mixed, requiring multi-modal pharmacology [43].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“For musculoskeletal pain, current research confirms the beneficial effect of physiotherapy on both pain intensity and on physical function [53].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Initial clinical trial results indicate the potential for huge benefit, though the sample size was small [56].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Most patients using alternative medicine do so in conjunction with conventional healthcare [58].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Current research suggests that inappropriate NSAID prescribing is common and needs to be addressed urgently to improve patient safety [45].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Management of Chronic Pain in Primary Care
What the sources say
- Not checked yetcites [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
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Emerging Research in Chronic Pain
What the sources say
- Not checked yetcites [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 yetcites [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
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, there continues to be a relative lack of high-quality primary-care-focused research in chronic pain.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The use of telecare in patients with chronic pain is growing an evidence base suggesting it is beneficial in chronic pain management.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Emerging Research in Chronic Pain
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Emerging Research in Chronic Pain
What the sources say
- Not checked yetcites [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.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Conclusion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
What the sources say
- Not checked yetcites [63] Society TBP, editor. Guidelines for pain management programmes for adults. London: The British Pain Society; 2013.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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.”
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?
In the citing paper
“International clinical guidelines also recommend the inclusion of self-management interventions in routine treatment for patients living with chronic pain [2].”
From Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study (2020) · cites this paper as [2]
In the citing paper
“Given this intricacy, chronic pain is optimally managed by treatments that address not only biological factors [2,3], but also psychological and social influences and consequences.”
From Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study (2020) · cites this paper as [2]
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Identification and Management of Chronic Pain in Primary Care: a Review > Introduction > Non-Drug or Complex Interventions
“The 2010 NICE guidelines for LBP advocate the use of spinal manipulation [60].”
§ Identification and Management of Chronic Pain in Primary Care: a Review > References
“60. Underwood M, Watson P, et al. Low back pain | Guidance and guidelines | NICE. 2009;CG88.”
Citations
Cites
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A Chronic Pain Self-Management Mobile App (Dolodoc): Cross-Sectional Acceptability Study
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Metadata
- Authors
- Mills, S., Torrance, N., & Smith, B. H.
- Affiliations
- University of Dundee (GB)
- Corresponding author
- Mills, Sarah
- Venue
- Current Psychiatry Reports
- Published
- 2016-01-28
- Volume
- 18
- Issue
- 2
- Pages
- 22-22
- ISSN
- 1523-3812 (ISSN-L)
- 1535-1645
- 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
- hybrid
- doi.org
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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
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