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Persistent musculoskeletal pain: osteoarthritis and back pain

GPs & clinicians Residents & families Aged care staff 7 min read

By Dr Josh Hatch, FRACGP

Arthritis is one of the conditions most strongly linked with pain in nursing home residents 2. How often osteoarthritis is recorded varies enormously, from 2.8% to 75.4% of residents across the nursing home studies that reported it, largely because it is documented so inconsistently 45.

Numbers in the text link to the 5 sources listed at the foot of this page.

Two Australian care standards

The Australian Commission on Safety and Quality in Health Care has published clinical care standards for knee osteoarthritis, revised in 2024, and for low back pain, published in 2022 1314.

Neither was written for residential aged care. The knee standard covers people aged 45 and over and notes that it may also be relevant in residential aged care services. The back pain standard covers people aged 16 and over in general practice and emergency departments 1314. Their principles still apply to residents, adjusted to what each person can do and wants.

What the knee osteoarthritis standard recommends

Summarised from the 2024 standard 13.

  • Diagnosis. Made clinically. Imaging is not used routinely, and MRI, CT and ultrasound are not appropriate for diagnosing knee osteoarthritis 13.

  • Exercise. Physical activity and exercise help pain and function. The standard states that exercise is safe for the knee, even with severe osteoarthritis 13.

  • Weight. Loss of excess weight reduces knee pain and improves function 13. In a frail resident this needs weighing against nutrition, and often does not apply.

  • Medicines. Medicines follow current guidelines, and opioids are not offered for knee osteoarthritis because the risk of harm outweighs the benefits 13.

  • Surgery. Joint replacement may be considered for severe symptoms despite non-surgical care. Arthroscopy is not offered for uncomplicated knee osteoarthritis 13.

What the low back pain standard recommends

Summarised from the 2022 standard 14.

  • Look for a serious cause. Assessment screens for specific or serious causes. For fracture, the standard lists considerable trauma, or minor trauma in a person over 50 or with osteoporosis or corticosteroid use. For cancer, a past history of cancer, age over 50, unexplained weight loss and pain at rest. Altered bladder or bowel function, such as urinary retention or faecal incontinence, raises concern about cauda equina syndrome 14.

  • Imaging. Reserved for suspected serious pathology, with its limited role explained 14.

  • Staying active. People are encouraged to stay active and return to usual activities as soon as they can 14.

  • Medicines. The aim is to enable activity, not to eliminate pain. Opioids are considered only in carefully selected patients, at the lowest dose for the shortest time. Benzodiazepines, anticonvulsants and antidepressants are avoided because their risks often outweigh potential benefits 14.

Back pain after a fall

Almost every resident is over 50, so by the standard’s criteria new back pain after even a minor fall warrants a medical review 14. Osteoporotic vertebral fractures can be painful 40. Bone health is covered in the falls section, and the trials of vertebroplasty are on the page about injections and procedures.

Related pages on this site

Sources cited on this page

  1. 2 Cole CS, Carpenter JS, Chen CX, et al. Prevalence and factors associated with pain in nursing home residents: a systematic review of the literature. J Am Med Dir Assoc. 2022;23(12):1916–25. (Systematic review of 26 descriptive studies, 2010–2020.) View source
  2. 13 Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard. Sydney: ACSQHC; first released 2017, revised August 2024. (Scope: people aged 45 and over.) View source
  3. 14 Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC; September 2022. (Scope: people aged 16 and over in primary care and emergency departments.) View source
  4. 40 Buchbinder R, Osborne RH, Ebeling PR, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med. 2009;361(6):557–68. View source
  5. 45 Austen S, Kamps I, Boonen AERCH, Schols JMGA, van Onna MGB. Prevalence of rheumatic and musculoskeletal diseases (RMDs) in nursing home residents: a systematic literature review. Eur Geriatr Med. 2024;15(5):1245–58. View source

See every source cited across the pain section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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