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The Medical Blind Spot for Aches, Pains & Injuries

Most physicians are unqualified to care for many common pain and injury problems, especially the more stubborn and tricky ones

updated (first published 2012)ARCHIVEDArchived pages are rarely or never updated. Most featured articles on PainScience.com are updated regularly over the years, but not archived pages.
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com

SUMMARY

Doctors lack the skills and knowledge needed to care for most common aches, pains, and injury problems, especially the chronic cases, and even the best are poor substitutes for physical therapists. This has been proven in a number of studies, like Stockard et al, who found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.” It’s just not their thing, and people with joint or meaty body pain should take their family doctor’s advice with a grain of salt.

full article 700 words

Medical training is better than the competition, but family doctors lack the skills and knowledge to treat most common aches, pains and injury problem, especially stubborn cases. Even the best general practitioners of medicine are poor substitutes for specialists,1 physical therapists, and some exceptional chiropractors and massage therapists. Most doctors are well aware of this, but some seem to be disconcertingly oblivious. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton:

Undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.

Medical incompetence in this area is unfortunate but understandable

Please cut doctors some slack on this. It’s not an insult to physicians.2 Doctors have to work with an astonishing array of conditions, and pain is often too subjective, slippery, and minor compared to other pathologies — it doesn’t get on their radar. Musculoskeletal pain is a bit of a backwater, simply because medicine had bigger fish to fry (e.g. curing major infectious diseases and so on).3

Nevertheless, the severity and importance of a lot of body pain was also underestimated — or even disbelieved — by too many doctors for too long. Medicine should now be taking pain more seriously.4

Medicine gives itself a failing grade in pain management

Medical researchers have done many studies showing that most doctors still do not understand aches and pains or heed expert recommendations. At the 2014 World Congress on Pain, Dr Andreas Kopf presented “3 Sad Realities”:

A paper in Archives of Internal Medicine showed that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al. More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.”5

Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.”6 In 2006, Stockard et al found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.7

So that pretty much tears it. Medicine gives itself a failing grade in this area.



About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Notes

  1. The medical specializations relevant to most common musculoskeletal pain and injury problems are physiatry, sports medicine, neurology. There are even pain specialists. BACK TO TEXT
  2. Criticism, yes. Chiding, even. But not an insult! BACK TO TEXT
  3. PS Ingraham. A Historical Perspective On Aches ‘n’ Pains: We are living in a golden age of pain science and musculoskeletal medicine … sorta. PainScience.com. 1897 words. BACK TO TEXT
  4. It’s presumptuous of me to prescribe medical priorities, but it’s not hard to make a case for it, and many doctors have done so. BACK TO TEXT
  5. Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am. 2002 Apr;84-A(4):604–608. PubMed #11940622.

    From the abstract: “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.”

    BACK TO TEXT
  6. Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005 Feb;87(2):310–314. PubMed #15687152.

    From the abstract: “… training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs.”

    BACK TO TEXT
  7. Stockard AR, Allen TW. Competence levels in musculoskeletal medicine: comparison of osteopathic and allopathic medical graduates. J Am Osteopath Assoc. 2006 Jun;106(6):350–355. PainSci #56560.

    From the abstract: “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”

    BACK TO TEXT