Psychological consequences

Though often dismissed as understandable, distress is a treatable cause of reduced quality of life and poorer clinical outcome. Some patients delay seeking help because they fear or deny their symptoms of distress. Presentation can be obvious, as depressed or anxious mood can manifest as increased severity of somatic complaints such as breathlessness, pain, or fatigue. Adjustment disorder is the commonest psychiatric diagnosis, and neuropsychiatric complications may occur. The risk of suicide...

Managing acute back pain

Most patients can be effectively managed with a combination of brief assessment and giving information, advice, analgesia, and appropriate reassurance. Minimal rest and an early return to work should be encouraged. Explanation and advice can be usefully supplemented with written material. Doctors' tasks include not only the traditional provision of diagnosis, investigation, prescriptions, and sickness certificates but also giving accurate advice, information, and reassurance. Primary care and...

Providing explanations after negative investigation

Even when tests are reported as normal, some patients are not reassured. Such patients may benefit from an explanation of what is wrong with them, not just what is not wrong. A cognitive behavioural model can be used to explain how interactions between physiology, thoughts, and emotion can cause symptoms without pathology. Simple headache provides an analogy the pain is real, and often distressing and disabling, but is usually associated with stress. Diagnoses such as tension headache and...

Primary care

Primary care doctors have a major responsibility for the continuing care of patients with angina and those with chronic non-cardiac chest pain, as well as a role in secondary prevention. They therefore need good communication with specialist cardiac services and access to appropriate resources, including psychological treatments. Patients with a low risk of coronary disease such as young women with no cardiac risk factors and atypical pain do not usually need cardiac investigation. Some,...

Identify risk factors for chronicity

Guidelines for primary care management of acute back pain highlight the identification of risk factors for chronicity. A useful approach has been developed in New Zealand. It aims to involve all interested parties patient, the patient's family, healthcare professionals, and, importantly, the patient's employer. Four groups of risk factors or flags for chronicity are accompanied by recommended assessment strategies, which include the use of screening questionnaires, a set of structured interview...