Taking the last interview before death participants were placed into one of twenty four cohorts on the basis of the number of months between interview and death and their responses compared with the background prevalence of pain

amongst participants of the same age who did not die. The authors found that the presence of arthritis was strongly associated with pain at the end of life. The prevalence of pain in the last month of life was 60% of people with arthritis versus 26% among people without arthritis (P <0.001). This did not differ by terminal disease category, Inhibitors,research,lifescience,medical nor was there any evidence for an interaction between arthritis and any terminal disease category [29]. During the two years before death the prevalence of pain remained stable at approximately 40% for people with arthritis and 14% for people without arthritis, until the last Inhibitors,research,lifescience,medical four months of life when it increased steadily to the prevalence figures reported above. Borgsteede et al [30] reported on the prevalence of symptoms in patients receiving palliative care at home. Their study was completed within the framework of a nationwide cross sectional study of general practice in the Netherlands. A representative sample Inhibitors,research,lifescience,medical of participating GPs received a questionnaire regarding patients who had received palliative care and died at home. Information was then retrieved from GP

records, using the international classification of primary care (ICPC), regarding the GP-patient Inhibitors,research,lifescience,medical encounters in the last three months for 429 patients.

Symptoms were WEEL phosphorylation classified into categories according to ICPC chapters. Musculoskeletal symptoms had a 20% prevalence in patient-physician encounters. Discussion The findings present a dichotomy of methods and focus with two epidemiological papers that suggest that musculoskeletal symptoms have a substantial impact at the end of life in the general population and four cases studies showing that musculoskeletal pain can be a significant issue for individuals requiring unusually sophisticated pain control Inhibitors,research,lifescience,medical measures including temporary sedation, cordotomy, arthroplasty and very high dose opiates. No information was found about not the way that musculoskeletal symptoms were assessed and treated in the general population. Despite this, the findings do give some indication of the prevalence, impact and treatment of musculoskeletal pain at the end of life. Prevalence The population based studies indicated that musculoskeletal pain is a common and significant issue at the end of life. Smith et al’s [29] study, the first epidemiological study to look at pain at the end of life, draws attention to the fact that musculoskeletal disease may have as much, if not more, effect on whether a person dies in pain than the condition that is the cause of death. Unfortunately, Smith et al [29] do not define what is mean by the term ‘arthritis’.