Musculoskeletal Pain (MSK Pain)

MSK Pain is one of the symptoms with the highest frequency when seeking medical care, and among patients suffering from pain, half of the final diagnosis are due to musculoskeletal cause.4 Before we explain more in detail about the MSK-pain, we should talk a little more about pain, what is actually pain?  Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage 1 ”. According to the IASP-10 7, we categorize pain into three main sub-categories: the Nociceptive pain, the Neuropathic pain and recently the new sub- category named: Nociplastic pain.  Nociceptive pain: Is the pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors, 1  Neuropathic pain: Is the Pain caused by a lesion or disease of the somatosensory nervous system 1 Nociplastic Pain: Is the Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.2 Recently a large body of researchers guided by Rainer Freynhagen and his team, argued that there is a gab in Pain definitions, and therefore he suggested an additional term named mixed pain. Mixed pain is a complex overlap of the different known pain types (nociceptive, neuropathic, and nociplastic) in any combination, acting simultaneously and/or concurrently to cause pain in the same body area. Either mechanism may be more clinically predominant at any point of time. Mixed pain can be acute or chronic. 3

In musculoskeletal diseases, pain is the symptom that weighs the most in disease burden 5 and low back pain is the first cause of years lived with disability 6. In chronic pain conditions, it was shown that musculoskeletal pain was the most prevalent of all painful conditions. 6 In musculoskeletal pain, this renders it possible to classify fibromyalgia, complex regional pain syndrome, and nonspecific low back pain as primary pain disorders. 6 Chronic secondary musculoskeletal pain is due mostly to three main causes, they were integrated in the classification as follows:

– From persistent inflammation

– Associated with structural changes

– Due to diseases of the nervous system 6

In our clinic we emphasize in pain perception, and we encourage our patients to talk more about their pain. Very recently a questionnaire (pain DETECT) is available for all patients who suffer from chronic MSK pain. The answers will guide us further in order to understand more regarding the source and the kind of pain.

  1. Maentyselkae P, Kumpusalo E, Ahonen R, et al. Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain 2001;89:175e80.
  2. Briggs AM, Woolf AD, Dreinhoefer K, et al. Reducing the global burden of musculoskeletal conditions. Bull World Health Organ 2018;96:366e8.
  3. Hay SI, Abajobir AA, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990e2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017;390:1260e344.
  4. Breivik H, Collett B, Ventafridda V, et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287e333.
  5. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019;160:19e27.
  6. Perrot S, Cohen M, Barke A, et al. The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain. Pain 2019;160:77e82.
  7. IASP. https://www.iasp-pain.org/terminology?navItemNumber.576#Pain

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