Papers of the Week

Because musculoskeletal pain problems are so prevalent, new methods of evaluating and treating patients are needed to increase effectiveness. Subgrouping is a method where patients are classified into defined groups based on psychosocial factors with the expectation of more specific and tailored treatments for them. For those seeking care for a new episode, the risk of developing chronic pain-related disability is assessed, while for those with existing pain the risk for the maintenance of the chronic pain problem is evaluated. In this narrative review we examine the subgrouping of patients with regard to methods of evaluation as well as to whether subgrouping actually facilitates treatment. For the development of disability, screening tools e.g. the Örebro Musculoskeletal Pain Screening Questionnaire accurately stratify patients into group (e.g. high, medium, low risk) that predict future pain-related work disability. In addition, several studies show that treatments that directly key on risk groups enjoy enhanced outcomes compared to treatment as usual. For the maintenance of chronic musculoskeletal pain problems there are several instruments that classify patients into specific groups or profiles e.g. based on the avoidance and endurance model or the ICF assessment. While some evidence shows that these classifications are related to treatment outcome, we found no study that directly tested a system for providing treatment matched to the subgrouping for maintenance. We conclude that it is possible to reliably subgroup patients with musculoskeletal problems. Likewise, treatments that address the risk factors in the screening procedure, may enhance outcomes compared to treatment as usual. More work is needed however, to better understand mechanism so assessment methods can be improved and treatment specific to subgroups can be developed.