What?
FCPs need to have high levels of clinical confidence in triaging whether a service user's pain is of MSK origin or not, and they my must do this quickly, effectively and accurately in order to maintain safety. Having taken a year's break from my FCP role, I found that my confidence in recognising non-MSK causes of pain has diminished.
So what?
Before returning to a triage role, in order to effectively use critical thought to manage complex cases, I needed to restore this confidence. This maintains service users' safety, allows for appropriate and timely clinical decisions to be made that are in their best interest, and helps to develop the "Clinical" pillar of advanced-level practice.
Now what?
The MACP held a course on "Spinal Masqueraders" in March of 2021. The aim of the course was to empower physiotherapists to recognise conditions which mimic MSK pain in their symptom profile, but have a systemic cause. Examples of this included: Multiple Myeloma and other blood cancers, which can cause spinal and pelvic pain; tuberculosis, which can cause spinal pain and even neurogenic symptoms, often in the absence of constitutional symptoms: and MND, which can cause symptoms that can seem quite innocuous in the early stages, such as foot drop or joint pains.
This course was a welcome refresher to my previous diagnostic knowledge, but also greatly added to it, particularly in terms of early symptom recognition and helpful risk factors to consider. It also touched on an area I had never even considered before: what happens to CES patients once they are in front of a spinal surgeon?
My knowledge of CES was very much limited to "Recognise a few cardinal symptoms, ask a few cardinal questions, zip them off to ED if you think they have CES" and everything should be fine from that point onwards. I had never considered anything more about CES than getting these patients in front of a surgeon as quickly as possible, and certainly hadn't considered the journey of those who make it to a surgeon in time, yet still have poor QOL outcomes (1 in 5!). Given that there is no widely accepted diagnostic criteria, a highly variable symptom profile, and poor validity/reliability of anal tone/saddle sensation testing, I now see the incredible importance of being able to recognise signs and have a low threshold for referral.
Despite this course being excellent, I must say I don't really feel any more confident in being able to recognise signs of blood cancers that mimic spinal pain. If I was in the situation where a service user had seen me as an FCP, they had spinal pain which "didn't feel right", and I thought it wasn't an infective process, I think I would most likely flounder and pass the baton on to a GP. Something which I think would give me a greater sense of security, and also prevent the consult being a waste of service users' time, would be for me to feel confident with requesting some sensible blood tests in the mean time, before booking a GP review so they had some useful results to consider during the next clinical contact. The MACP also host a course on this, which I will endeavour to get a space on to complement this learning.