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Pain study finds health system chronically ill

Does this Swiss doctor know what he is doing?

(Keystone)

Findings from a government-sponsored study into how doctors treat chronic pain are in part a condemnation of Switzerland's exploding health costs.

The authors of the study, "Musculoskeletal Heath – Chronic Pain", said that many treatments including surgery were often carried out unnecessarily.

Lead author Andreas Stuck, a geriatrics specialist at Bern University, told swissinfo.ch that the study revealed, for example, surgery for hip, shoulder or knee problems was scheduled 40 times more often in some regions than in others.

"Orthopaedic measures are used when in fact other treatments would have been preferable and the orthopaedic procedure would not have been required. This would have been less costly and perhaps even more effective," Stuck said.

While the authors have no conclusive evidence as to why there are such large differences between Swiss regions, Stuck says the example does highlight the lack of guidelines for physicians to follow when treating patients with chronic ailments.

The five-year study, funded through the National Research Programme, also found that some types of common treatments are ineffective, including electrical stimulation and injections into joints.

On the other hand, some doctors are reluctant to recommend any treatment at all, preferring instead to prescribe painkillers when physiotherapy would in fact deliver results.

Stuck says he hopes the study will lead to universally accepted guidelines since the conclusions "demonstrate that more clarity is needed on what kind of treatment and diagnostic procedure is offered, and at what point".

The comprehensive chronic pain study includes more than two dozen investigations into various aspects of musculoskeletal ailments, how they are treated and the long term impact. The results of three of the projects were presented at a news conference in Bern on Thursday.

Chronic costs

The confusion that reigns on the chronic pain front has major implications for Switzerland's health care system – one of the most expensive worldwide - and the government's efforts to control costs.

It is estimated that people suffering from musculoskeletal ailments cost Swiss taxpayers up to SFr14 billion ($13.69 billion) a year or 3.2 per cent of Gross Domestic Product.

Almost a third of all consultations with physicians are due to such complaints. And employers lose SFr4.3 billion a year through sick days taken by staff suffering from back pain.

Research into different ways of treating back pain found that patients who received physiotherapy took fewer sick days over a three-year period and cost the system around SFr10,000 less than those who were only prescribed painkillers.

Pro-active therapy

"In the case of back pain, there needs to be a more pro-active, function-centred, early rehabilitation therapy," Stuck says.

"This has been well known for several years, but it has not found its way into doctors' practices. In some cases the primary care physician has recommended that patients should not move too much, and not to return to work too early, when in fact, they should do the opposite."

The main findings of the chronic pain study are sobering. The authors concluded that a health care system spending approximately SFr4,000 a year per capita lacks an effective early diagnosis system and does too little in the area of prevention.

Employers are given their share of the blame for reacting too late to staff members suffering from chronic back pain. And patients need to take more personal responsibility for dealing with their ailments, added the experts.

Dale Bechtel, swissinfo.ch

The study

National Research Programme 53, "Musculoskeletal Heath – Chronic Pain", is a programme of research on musculoskeletal health in the Swiss population. The aim is to develop ways to promote musculoskeletal health more effectively.

The five-year interdisciplinary research programme analysed the status of musculoskeletal health in Switzerland and identified underlying determinants. Some of the studies provide recommendations for optimising health in specific groups in the population that are at high risk from musculoskeletal disorders.

Musculoskeletal disorders are often accompanied by long-term, chronic pain. Another aim of the study is to develop new therapies for better treatment of pain in the musculoskeletal system.

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Musculoskeletal system

The human musculoskeletal system is made up of the body's bones, muscles, cartilage, tendons, ligaments, joints, and other connective tissue.

Its primary functions include supporting the body, allowing motion, and protecting vital organs. The skeletal portion of the system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system.

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