Michael E. Ohl, Gary E. Rosenthal
Chronic musculoskeletal pain accounts for an estimated 60 million ambulatory care visits in the United States each year and significantly impairs quality of life.1,2 Management of chronic musculoskeletal pain is frequently frustrating, both for patients and for their primary care physicians. Underrecognition and undertreatment of chronic pain have led to routine measurement and documentation of pain as “the fifth vital sign” as well as efforts to increase awareness of pain symptoms among clinicians.3 However, in the absence of effective systems for implementing evidence-based approaches for treating chronic pain, improved awareness of pain has resulted in increased and sometimes indiscriminate prescribing of chronic opioids, with harmful effects.4 Because of the high prevalence of chronic pain and the limited capacity of specialty pain clinics, effective interventions are needed that can be safely and widely implemented by primary care practices.
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