Management of musculoskeletal pain

Journal: Best Practice & Research. Clinical Rheumatology. 2007 Feb;21(1):153-66.

Author and affiliation: Bergman, S. Spenshult Hospital, Oskarstrom, Sweden.

PMID: 17350550

Chronic musculoskeletal pain is a major public health problem affecting about one third of the adult population. Pain is often present without any specific findings in the musculoskeletal system and a strictly biomedical approach could be inadequate. A biopsychosocial model could give a better understanding of symptoms and new targets for management.

Identification of risk factors for chronicity [pain becoming chronic] is important for prevention and early intervention. The cornerstones in management of chronic non-specific, and often widespread, musculoskeletal pain are non-pharmacological. Physical exercise and cognitive behavioral therapy, ideally in combination, are first line treatments, for example in chronic low back pain and Fibromyalgia.

Analgesics are useful when there is a specific nociceptive [pain-causing] component, but are often of limited usefulness in non-specific or chronic widespread pain (including Fibromyalgia). Antidepressants and anticonvulsants could be of value in some patients but there is a need for more knowledge in order to give general recommendations.

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