Also 19% of Smith et al’s [29] data was obtained by proxies who may have underreported musculoskeletal symptoms [16]. Smith et al’s [29] study used the time between interview and death to document a significant increase in pain prevalence in Selleck LY2835219 people with arthritis as death approached. The authors highlighted the limitations of using cross sectional data in this fashion. Despite this, the findings emphasise the need to be especially vigilant for pain in people with co-morbid musculoskeletal

disease in the final months of life [32]. Borgsteede et al [30] supported this by showing that musculoskeletal Inhibitors,research,lifescience,medical symptoms were prevalent in at least 20% of patient-GP encounters during the last three months of life. This is higher than the 14% annual prevalence of GP consultations for musculoskeletal Inhibitors,research,lifescience,medical disease in the general population reported by Jordan et al [33]. However, the studies were undertaken in different countries and used different systems for classifying consultation data making direct comparison difficult. Furthermore, Borgsteede et al [30]

gave no information about Inhibitors,research,lifescience,medical the nature or severity of the symptoms, nor does it discuss how, or whether, they were successfully managed in practice. Borgsteed et al [30] suggested that their study may have underestimated the prevalence of musculoskeletal symptoms as GP’s were unlikely Inhibitors,research,lifescience,medical to register all the symptoms affecting patients at the end of life and the records represented the most important symptoms as perceived by the GPs, rather than documenting the patients perspective [30]. Smith et al [29] may also have a systematic bias underestimating the true prevalence of musculoskeletal pain. The health and retirement study excluded people living in institutions, and admission to care homes

is commonly prompted by reduced physical functioning [34]. Although both population based studies Inhibitors,research,lifescience,medical found musculoskeletal disease had a significant impact at the end of life, the prevalence of symptoms recorded varied significantly: 60% in Smith et al [29] and 20% in Borgsteede et al [30]. As Smith et al [29] does not discuss how ‘arthritis’ was defined and Borgsteede et al [30] do not discuss the nature to of the musculoskeletal symptoms, comparison is difficult. The extent of the disparity is similar to that observed when estimates of musculoskeletal pain from population surveys are compared with estimates derived from coded primary care data, with surveys consistently suggesting that only a minority of people raise the issue of even severe musculoskeletal pain with their GP [35]. Nevertheless the fact that these figures do not more closely correspond provides tentative initial support for the idea that musculoskeletal pain is common at the end of life, but underestimated as a cause of pain by healthcare professionals.