• Lisa C Carlesso, Debbie Ehrmann Feldman, and Richard L Nahin.
• From the School of Rehabilitation Science, McMaster University, Hamilton, Canada, School of Rehabilitation, Physiotherapy Program Université de Montréal, Montreal, Canada (LCC); School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, Canada (DEF); National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD (RLN). carlesl@mcmaster.ca.
• J Am Board Fam Med. 2021 May 1; 34 (3): 618-633.

PurposeTo explore medical diagnostic testing of new cases of musculoskeletal (MSK) conditions associated with chronic pain.MethodsWe analyzed nationally representative cross-sectional data of people having visits with a new likely chronic MSK pain condition. We documented depression screening and prescribing of diagnostic imaging and blood tests and explored associations between patient and provider factors for each.ResultsOver the 9 years of the survey, there were 11,994 initial visits for chronic MSK pain, an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions for depression screening, prescribed imaging, and blood tests were 1.79%, 36.34%, and 9.70%, respectively. People on any public health insurance had twice the increased relative odds to be screened for depression. Orthopedists had 3 times increased relative odds to prescribe imaging compared with family physicians; oncologists had 4 times increased relative odds to prescribe blood tests. Survey year was significantly associated with depression screening and ordering any type of imaging.ConclusionsObserved rates of depression screening and nonindicated imaging for patients with chronic MSK pain have fluctuated over time. The impact of these fluctuations on clinical practice is as yet unknown. The type of nonrecommended actions varied by specialty of physician.© Copyright 2021 by the American Board of Family Medicine.

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