Specific and non-specific complaints

There are different ways to classify complaints. A frequently used one is that in specific and non-specific complaints. It is actually the classification into medically important and minor complaints and determines to a large extent which treatment makes sense.

Specific complaints

This is the group in which a medical cause for the complaints has been found. Examples are bone fracture, infection, tumor, myocardial infarction, stomach ulcer, disorder in the immune system, lack of an enzyme (certain type of molecule), and so on. In order to determine this, additional medical examinations are often required, such as photographs, scan, blood tests or other tests. The medical diagnosis often leads to a targeted medical treatment: a bone fracture is set and immobilized, an infection is treated with antibiotics, a tumor can be irradiated or operated. Fortunately, most complaints are no specific complaints.

Non-specific complaints

Most back and neck complaints (estimated at 90-95%) are in this group: no medical causes have (yet) been demonstrated and in the first instance it is not clear what is going on. Many chronic complaints are also included, such as fibromyalgia, chronic fatigue syndrome, post-whiplash syndrome, kneecap complaints and much more. Acute non-specific (back and neck) complaints improve in 75-90% of patients without therapy. However, 1 in 2 patients develops symptoms again in the following year, and about 1 in 4 patients develops chronicity. Non-specificity remains with the majority of patients. It is possible that, due to advancing research techniques and insights, some of these complaints appear to have a specific cause. Then a shift to that group takes place.

Role of musculoskeletal medicine

The fact that no medical cause is found in the group of non-specific complaints does not mean that proper treatment is not available. In musculoskeletal medicine it is precisely this group that is further examinated and classified into subgroups based on the characteristics of the symptoms and the patient. How? Through a good history and physical examination. A targeted policy can then often be implemented. In this study the risk (= chance of recurrence) and prognostic (= possibly influenceable) factors are investigated. Particular attention is paid to the genesis, influence of postures and movements, day rhythm, limitations of and by the complaints. In the case of chronic complaints, personal and environmental factors are also important: how does the patient deal with the complaint? What are the requirements that the environment imposes on the patient?

Various ways of subclassifying non-specific complaints can be found in the literature. Having knowledge of this makes it possible to choose a specific approach for each patient. There is evidence that this improves the effectiveness compared to the policy in standards and guidelines. Thus, the therapeutic policy in musculoskeletal medicine has various options such as correcting or improving posture, position, movement, stability, control. This in addition to general measures such as informing and activating.

References

Balagué F et al. Non-specific low back pain. Lancet 2012; 379: 482–91.

Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Rel Res; 1987(217):266-280.

Bons SCS et al. NHG-Standaard Aspecifieke lagerugpijn (Tweede herziening) 2017.

Brennan GP et al. Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: results of a randomized clinical trial. Spine. 2006;31:623-631.

Deyo RA, et al. What can the history and physical examination tell us about low back pain. JAMA 1992; 268: 760-765.

Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. 2003;28:1363-1371; discussion 1372.

Karayannis NV. Physiotherapy movement based classifications approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskeletal Disord. 2012; 20:13-24.

Vibe Fersum K, O’Sullivan P, Skouen JS, et al. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013; 17:916–928.