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Pain and Therapy
Published in: Pain and Therapy 1/2021

Open Access 01-06-2021 | Neuropathic Pain | Review

Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain

Authors: Salah N. El-Tallawy, Rohit Nalamasu, Gehan I. Salem, Jo Ann K. LeQuang, Joseph V. Pergolizzi, Paul J. Christo

Published in: Pain and Therapy | Issue 1/2021

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Abstract

Musculoskeletal pain is a challenging condition for both patients and physicians. Many adults have experienced one or more episodes of musculoskeletal pain at some time of their lives, regardless of age, gender, or economic status. It affects approximately 47% of the general population. Of those, about 39–45% have long-lasting problems that require medical consultation. Inadequately managed musculoskeletal pain can adversely affect quality of life and impose significant socioeconomic problems. This manuscript presents a comprehensive review of the management of chronic musculoskeletal pain. It briefly explores the background, classifications, patient assessments, and different tools for management according to the recently available evidence. Multimodal analgesia and multidisciplinary approaches are fundamental elements of effective management of musculoskeletal pain. Both pharmacological, non-pharmacological, as well as interventional pain therapy are important to enhance patient’s recovery, well-being, and improve quality of life. Accordingly, recent guidelines recommend the implementation of preventative strategies and physical tools first to minimize the use of medications. In patients who have had an inadequate response to pharmacotherapy, the proper use of interventional pain therapy and the other alternative techniques are vital for safe and effective management of chronic pain patients.
Literature
1.
Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59.CrossRef
2.
3.
Smith E, Hoy DG, Cross M, et al. The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:1462–9.PubMedCrossRef
4.
Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25:173–218.PubMedCrossRef
5.
Babatunde OO, Jordan JL, Windt DA, et al. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS ONE. 2017;12:e0178621.PubMedPubMedCentralCrossRef
6.
Ernstzen DV, Louw QA, Hillier SL. Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review. Implement Sci. 2017;12:1.PubMedPubMedCentralCrossRef
7.
Merskey H, Fessard D, Bonica JJ, et al. Pain terms: a list with definitions and notes on usage. Recommended by the IASP subcommittee on taxonomy. Pain. 1979;6:249–52.
8.
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.PubMedCrossRef
9.
10.
Bedson J, Mottram S, Thomas E, Peat G. Knee pain and osteoarthritis in the general population: what influences patients to consult? Fam Pract. 2007;24:443–53.PubMedCrossRef
11.
James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858.CrossRef
12.
Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25(2):173–83.PubMedCrossRef
13.
14.
15.
16.
17.
18.
19.
Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher C, O’Sulliva P. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54:79–86.PubMedCrossRef
20.
Ivanova JI, Birnbaum HG, Schiller M, et al. Real- world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. Spine J. 2011;11:622–32.PubMedCrossRef
21.
Cho NH, Jung YO, Lim SH, Chung CK, Kim HA. The prevalence and risk factors of low back pain in rural community residents of Korea. Spine. 2012;37:2001–10.PubMedCrossRef
22.
23.
Abdel Shaheed C, Maher CG, Williams KA, et al. Efficacy, tolerability, and dose- dependent effects of opioid analgesics for low back pain: a systematic review and meta- analysis. JAMA Intern Med. 2016;176:958.PubMedCrossRef
24.
Manchikanti L, Kaye AM, Knezevic NN, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2017;20:S3–S92. ISSN 1533-3159.
25.
26.
Adelani MA, Harris AH, Bowe TR, et al. Arthroscopy for knee osteoarthritis has not decreased after a clinical trial. Clin Orthop Relat Res. 2016;474:489.PubMedCrossRef
27.
Ketola S, Lehtinen JT, Arnala I. Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J. 2017;99-B:799–805.PubMedCrossRef
28.
29.
30.
Russell IJ. Future perspectives in generalised musculoskeletal pain syndromes. Best Pract Res Clin Rheumatol. 2011;25(2):321–31.PubMedCrossRef
31.
Dieppe P. Chronic musculoskeletal pain. BMJ (Clin Res Ed). 2013;346:f3146.
32.
Cox F. Basic principles of pain management: assessment and intervention. Nurs Stand. 2010;25(1):36–9.PubMedCrossRef
33.
34.
Sinatra R. Pain pathways and pain processing. In: Sinatra RS, de Leon-Cassasola O, Ginsberg B, Viscusi G, editors. Acute pain management. Cambridge: Cambridge University Press; 2009. p. 3–21.CrossRef
35.
36.
Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. Acute pain management: scientific evidence fourth edition, 2015. Med J Aust. 2016;204(8):315–7.PubMedCrossRef
37.
38.
Bates D, Schultheis DC, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR, Levy RM, Hunter CW. A Comprehensive algorithm for management of neuropathic pain. Pain Med. 2019;20:S2–12.PubMedPubMedCentralCrossRef
39.
40.
41.
Rosenquist RW, Benzon HT, Connis RT, et al. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:1–1.
42.
43.
44.
Chou R, Gordon DB, de Leon-Casasola OA, et al. Guidelines on the management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists. J Pain. 2016;17(2):131–57.PubMedCrossRef
45.
Bennett MI, Attal N, Backonja MM, Baron R, Bouhassira D, Freynhagen R, Scholz J, Tolle TR, Wittchen HU, Staehelin T. Using screening tools to identify neuropathic pain. Pain. 2007;127:199–203.PubMedCrossRef
46.
47.
48.
49.
Loeser JD. Multidisciplinary pain programs. In: Loeser JD, editor. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins; 2001. p. 255–64.
50.
DeLisa JA. Treatment of the patient with chronic pain. In: DeLisa’s physical medicine & rehabilitation. Principles and practice. 5th ed. Philadelphia: Lippincott, Williams & Wilkins; 2010. p. 1273–318.
51.
King JC, Kelleher WJ. The chronic pain syndrome: the in-patient interdisciplinary rehabilitative behavioral modification approach. Phys Med Rehabil Stars. 1991;5:165–86.
52.
53.
Yang J, Bauer BA, WahnerRoedler DL, Chon TY, Xiao L. The modified WHO analgesic ladder: is it appropriate for chronic non-cancer pain? J Pain Res. 2020;13:411–7.PubMedPubMedCentralCrossRef
54.
Graham GG, Davies MJ, Day RO, et al. The modern pharmacology of paracetamol: therapeutic actions, mechanism of action, metabolism, toxicity and recent pharmacological findings. Inflammopharmacology. 2013;21(3):201–32.PubMedCrossRef
55.
Da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Juni P, et al. Effectiveness of non- steroidal anti- inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2017;390:e21-33.PubMedCrossRef
56.
57.
58.
59.
Vallejo R, Barkin RL, Wang VC. Pharmacology of opioids in the treatment of chronic pain syndromes. Pain Physician. 2011;14(4):E343–60.PubMedCrossRef
60.
61.
62.
Phillips JK, Ford MA, Bonnie RJ. Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. National Academies of Sciences. National Academies Press (US); 2017. ISBN-13: 978-0-309-45954-9, ISBN-10: 0-309-45954-0.
63.
Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276–86.PubMedCrossRef
64.
Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569–76.PubMedCrossRef
65.
66.
Wright ME. An update on the pharmacologic management and treatment of neuropathic pain. J Am Acad Physician Assist. 2017;30(3):13–7.CrossRef
67.
68.
Annemans L. Pharmacoeconomic impact of adverse events of long-term opioid treatment for the management of persistent pain. Clin Drug Investig. 2011;31(2):73–86.PubMedCrossRef
69.
Takkouche B, Montes-Martinez A, Gill SS, Etminan M. Psychotropic medications and the risk of fracture: a meta-analysis. Drug Saf. 2007;30(2):171–84.PubMedCrossRef
70.
71.
72.
73.
Plested M, Budhia S, Gabriel Z. Pregabalin, the lidocaine plaster and duloxetine in patients with refractory neuropathic pain: a systematic review. BMC Neurol. 2010;10:116.PubMedPubMedCentralCrossRef
74.
75.
76.
77.
Manchikanti L, Centeno CJ, Atluri S, et al. Bone marrow concentrate (BMC) therapy in musculoskeletal disorders: evidence-based policy position statement of American Society of Interventional Pain Physicians (ASIPP). Pain Physician. 2020;23:E85–E131. ISSN 2150-1149.
78.
Raff M, Belbachir A, El-Tallawy S, Ho KY, Nagtalon E, Salti A, Seo JH, Tantri AR, Wang H, Wang T, Buemio KC, Gutierrez C, Hadjiat Y. Intravenous oxycodone versus other intravenous strong opioids for acute postoperative pain control: a systematic review of randomized controlled trials. Pain Ther. 2019;8(1):19–39.PubMedPubMedCentralCrossRef
79.
Pergolizzi JV, Raffa RB. Safety and efficacy of the unique opioid buprenorphine for the treatment of chronic pain. J Pain Res. 2019;12:3299–317.PubMedCrossRef
80.
Beal BR, Wallace MS. An overview of pharmacologic management of chronic pain. Med Clin N Am. 2016;100(1):65–79.PubMedCrossRef
81.
Kaye AD, Cornett EM, Hart B, et al. Novel pharmacological nonopioid therapies in chronic pain. Curr Pain Headache Rep. 2018;22(4):31.PubMedCrossRef
82.
vanTulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic non-specific low back pain: a systematic review of randomized control trials of the most common interventions. Spine. 1997;22:2128–56.CrossRef
83.
Abenhaim L, Rossignol M, Valat JP, et al. The role of activity in therapeutic management of back pain: report of the international Paris task force on back pain. Spine. 2000;25:1S-33S.PubMedCrossRef
84.
Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166:514.PubMedCrossRef
85.
Swenson C, Sward L, Karlsson J. Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996;6(4):193–200.PubMedCrossRef
86.
Gooch JL, Geiringer SR, Akau CK. Sports medicine. 3. Lower extremity injuries. Arch Phys Med Rehabil. 1993;74:S438–42.PubMed
87.
Fischer E, Solomon S. Physiological responses to heat and cold. In: Licht S, editor. Therapeutic heat and cold. 2nd ed. Baltimore: Waverly; 1965. p. 126–69.
88.
Kottke FJ, Pauley DL, Rudolph PA. The rational for prolonged stretching for correction of shortening of connective tissue. Arch Phys Med Rehabil. 1966;47:345–52.PubMed
89.
90.
91.
Canthen JC, Renner EJ. Transcutaneous and peripheral nerve for chronic pain states. Surg Neural. 1975;11:102–4.
92.
Meyer GA, Fields HL. Causalgia treated by selective large fiber stimulation of peripheral nerve. Brain. 1972;95:163–8.PubMedCrossRef
93.
Hansson P, Lundeberg T. Transcutaneous electrical nerve stimulation and acupuncture. In: McMahon SB, Koltzenburg M, editors. Wall and Melzack’s textbook of pain. 5th ed. Philadelphia: Elsevier Churchill Livingstone; 2006. p. 583–90.
94.
95.
96.
97.
Wu WH, Akande AA. Alternative medicine for chronic pain: a critical review. In: Aronoff GM, editor. Evaluation and treatment in chronic pain. 3rd ed. Baltimore: Williams & Wilkins; 1998. p. 627–41.
98.
Mannion AF, Taimela S, Muntener M, et al. Active therapy for chronic low back pain, part I: effects on back muscle activation, fatigability, and strength. Spine. 2001;26(8):897–908.PubMedCrossRef
99.
100.
Peter WF, Jansen MJ, Hurkmans EJ, et al. Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation. Acta Reumatol Port. 2011;36:268–81.PubMed
101.
Bussières AE, Stewart G, Al- Zoubi F, et al. The treatment of neck pain- associated disorders and whiplash-associated disorders: a clinical practice guideline. J Manipulative Physiol Ther. 2016;39:523–64.PubMedCrossRef
102.
103.
National Institute for Health and Clinical Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). London: National Institute for Health and Clinical Excellence, NICE guideline Published: 30 November 2016 http://​www.​nice.​org.​uk/​guidance/​ng59.
104.
Wiegel M, Gottschaldt U, Hennebach R, Hirschberg T, Reske A. Complications and adverse effects associated with continuous peripheral blocks in orthopedic patients. Anesth Analg. 2007;104(1):1578–82.PubMedCrossRef
105.
Chelly JE, Ghisi D, Fanelli A. Continuous peripheral nerve blocks in acute pain management. Br J Anaesth. 2010;105(1):i86–96.PubMedCrossRef
106.
Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014;25(2):357–74.PubMedCrossRef
107.
108.
Park CJ, Shin YD, Lim SW, Bae YM. The effect of facet joint injection on lumbar spinal stenosis with radiculopathy. Pak J Med Sci. 2018;34(4):968–73.PubMedPubMedCentralCrossRef
109.
Manchikanti L, Kaye AD, Soin A, et al. Comprehensive evidence-based guidelines for facet joint interventions in the management of chronic spinal pain: American Society of Interventional Pain Physicians (ASIPP) guidelines. Pain Physician. 2020;23:S1–S127. ISSN 2150-1149.
110.
Boswell MV, Manchikanti L, Kaye AD, Bakshi S, Gharibo CG, Gupta S, Jha SS, Nampiaparampil DE, Simopoulos TT, Hirsch JA. A best-evidence systematic appraisal of the diagnostic accuracy and utility of facet (zygapophysial) joint injections in chronic spinal pain. Pain Physician. 2015;18(4):E497–533.PubMedCrossRef
111.
Roberts SL, Burnham RS, Ravichandiran K, Agur AM, Loh EY. Cadaveric study of sacroiliac joint innervation: implications for diagnostic blocks and radiofrequency ablation. Reg Anesth Pain Med. 2014;39(6):456–64.PubMedCrossRef
112.
113.
114.
115.
Lee JH, Kim DH, Kim DH, et al. Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Pain Physician. 2018;21(5):449468.
116.
Gharibo C, Koo C, Chung J, Moroz A. Epidural steroid injections: an update on mechanisms of injury and safety. Tech Reg Anesth Pain Manag. 2009;13:266–71.CrossRef
117.
118.
119.
Benyamin RM, Wang VC, Vallejo R, Singh V, Helm IS. A systematic evaluation of thoracic interlaminar epidural injections. Pain Physician. 2012;15(4):E497–514.PubMedCrossRef
120.
Manchikanti L, Manchikanti KN, Gharibo C, Kaye AD. Efficacy of percutaneous adhesiolysis in the treatment of lumbar post surgery syndrome. Anesth Pain Med. 2016;6(2):e26172.PubMedPubMedCentral
121.
Helm S, Racz GB, Gerdesmeyer L, Justiz R, Hayek SM, Kaplan ED, El Terany MA, Knezevic NN. Percutaneous and endoscopic adhesiolysis in managing low back and lower extremity pain: a systematic review and meta-analysis. Pain Physician. 2016;19(2):E245–82.PubMedCrossRef
122.
123.
124.
Helm Ii S, Simopoulos TT, Stojanovic M, Abdi S, El Terany MA. Effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician. 2017;20(6):447–70.PubMedCrossRef
125.
126.
127.
Song JJ, Popescu A, Bell RL. Present and potential use of spinal cord stimulation to control chronic pain. Pain Physician. 2014;17(3):235–46.PubMed
128.
Grider JS, Manchikanti L, Carayannopoulos A, Sharma ML, Balog CC, Harned ME, Grami V, Justiz R, Nouri KH, Hayek SM, Vallejo R, Christo PJ. Effectiveness of spinal cord stimulation in chronic spinal pain: a systematic review. Pain Physician. 2016;19(1):E33–54.PubMedCrossRef
129.
Hayek SM, Deer TR, Pope JE, Panchal SJ, Patel VB. Intrathecal therapy for cancer and non-cancer pain. Pain Physician. 2011;14(3):219–48.PubMedCrossRef
130.
Kongsgaard U, Kaasa S, Dale O, Ottesen S, Nordøy T, Hessling SE, von Hofacker S, Bruland ØS, Lyngstadaas A. Palliative treatment of cancer-related pain [Internet]. Oslo: Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2005. Report from Norwegian Knowledge Centre for the Health Services (NOKC) No. 09-2005.
Metadata
Title
Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain
Authors
Salah N. El-Tallawy
Rohit Nalamasu
Gehan I. Salem
Jo Ann K. LeQuang
Joseph V. Pergolizzi
Paul J. Christo
Publication date
01-06-2021
Publisher
Springer Healthcare
Published in
Pain and Therapy / Issue 1/2021
Print ISSN: 2193-8237
Electronic ISSN: 2193-651X
DOI
https://doi.org/10.1007/s40122-021-00235-2

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