Jun 23, 2020

Pain Management in Musculoskeletal Disease

Posted By: Thomas Einhorn, MD
pain management2

Musculoskeletal pain is pain that affects the muscles, ligaments and tendons, and bones. This pain is varied in that it can be localized to one particular area, widespread, have rapid-onset with severe symptoms (acute) or can be long-lasting (chronic). Lower back pain is the most common type of musculoskeletal pain. Other common types include tendonitis, myalgia (muscle pain), stress fractures or pain associated with arthritis.

What Causes Musculoskeletal Pain

It is most often caused by an injury to the bones, joints, muscles, tendons, ligaments, or nerves. This can be caused by jerking movements, car accidents, falls, fractures, sprains, dislocations, and direct blows to the muscle. Nevertheless, Musculoskeletal pain can also be caused by overuse. Pain from overuse affects 33% of adults. Lower back pain from overuse is the most common work-related diagnosis in Western society. Poor posture or prolonged immobilization can also cause musculoskeletal pain.


Your doctor will conduct a thorough physical examination and medical history. In addition, your doctor may perform diagnostic studies to confirm the diagnosis.

The Use of Opioids in Treatment

Opioids are commonly used as a musculoskeletal pain treatment. The United States has experienced an increase in the rates and quantities of opioids prescribed with a peak in 2010. Although the rate of prescriptions has declined, the amount of opioids prescribed in 2015 in the US is still four times higher than in Europe and three times higher than in the United States in 1999. Unfortunately, the rise in prescribing has paralleled a sharp rise in opioid-related overdoses and the rate of opioid-related deaths has continued to increase.

Orthopedic surgery is often times associated with substantial perioperative pain the fear of this pain has been cited as a major reason why patients delay knee or hip arthroplasty.

At this time opioid use for chronic and acute pain is common. Orthopedic surgeons are frequently the individuals writing the prescriptions for these drugs. Prescriptions for opioids occur with high variation for acute pain. Incorporation of a multimodal pain management strategy is an important part of any well-designed pain management program.

Although opioids are an effective pain treatment in musculoskeletal disease, the morbidity and mortality related to their use reinforces the need for robust evidence-based guidelines. Orthopedic surgeons and other providers of musculoskeletal care should evaluate patient risk preoperatively and prescribe judiciously.

The international Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Differentiating acute pain from chronic pain is based on timing and the duration of acute pain reflected in the mechanism and severity of the underlying cause. Acute postoperative pain is expected to subside during the process of tissue healing typically within three months after a procedure.

Degenerative joint-related pain in osteoarthritis is highly prevalent and occurs in about 12% of the population of United States. Primary total hip and knee arthroplasties are among the most common surgical procedures performed in the US. The prevalence of these procedures is expected to continue as a result of the aging population. Low back pain is the second most common symptom presenting for a physician visit in the United States and opioids are commonly prescribed for chronic pain relief. Preoperative use of opioids is common and reported in 65% of patients presenting for spinal procedures and 33% of patients presenting for joint arthroplasty.

Although opioids are is effective for the management of musculoskeletal pain, morbidity and mortality associated with their use reinforces the need for evidence-based guidelines. Despite research on the effectiveness of opioid alternatives such as NSAIDs, acetaminophen, and gabapentinoids, there is not a large body of evidence on the comparative effectiveness of these strategies. There is even less research addressing the comparative efficacy of pharmacological and non-pharmacological methods of the pain management. Further research must address these gaps in our knowledge.

References :

  1. LDelaney et al. J. Bone Joint Surg., 2020:102 Suppl 1:3-9.
  2. Musculoskeletal Pain and Diagnosis
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