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

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

doi:10.1007/s40122-021-00235-2

“…Although this study focused on pharmacotherapeutic pain management, the management of pain should involve a multiprofessional approach and consider suitable non-pharmacological treatment options, which may be valuable and successful in the management of chronic pain [ 43 ]. A close interaction and collaboration of the treating ALS specialist with a physical and/or occupational therapist, a clinical psychologist, rehabilitation professionals and a pain physician, as needed and depending on local resources and available expertise, will help to respond appropriately to pain-related impairments [ 27 , 32 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

Vogt

¹

,

Schlichte

²

,

Schreiber

³

et al. 2021

JCM

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Background: Although pain is common in amyotrophic lateral sclerosis (ALS) and an effectively treatable symptom, it is widely under-recognized and undertreated. This study investigates epidemiological and clinical characteristics of pain, its impact and pharmacological treatment in ALS patients. In addition, opportunities for further optimization of pain therapy need to be identified. Methods: Patients from three German ALS outpatient clinics were asked to complete the Brief Pain Inventory and the ALS Functional Rating Scale—Extension and to participate in semi-structured telephone interviews. Results: Of the 150 study participants, 84 patients reported pain. Pain occurred across all disease stages, predominantly in the neck, back and lower extremities. It was described with a broad spectrum of pain descriptors and mostly interfered with activity-related functions. Of the 84 pain patients, 53.8% reported an average pain intensity ≥4 on the numerical rating scale (NRS), indicating pain of at least moderate intensity, and 64.3% used pain medication. Irrespective of the medication type, 20.4% of them had no sufficient pain relief. Thirteen out of 30 patients without pain medication reported an average NRS value ≥4. Eleven of them—mainly in the context of high pain interference with daily functions—were supposed to benefit from adequate pain therapy. However, many patients had relevant concerns and misconceptions about pain therapy. Conclusion: Given the frequency, extent and multi-faceted impact of pain, it is necessary to systematically assess pain throughout the disease course. Potentials to optimize pain therapy were seen in the subset of patients with insufficient pain relief despite medication and in those patients without pain medication but high pain interference. However, there is a need to respond to patients’ barriers to pain therapy.

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“…Patients with MSK pain present with a broad array of symptoms, including body aches, malaise, stiffness, fatigue, and sleep disorders [ 6 , 7 , 8 , 9 ]. The treatment of this condition, especially when chronic, should be based on a multimodal rehabilitation approach tailored to the patients’ needs and expectations [ 6 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with MSK pain present with a broad array of symptoms, including body aches, malaise, stiffness, fatigue, and sleep disorders [ 6 , 7 , 8 , 9 ]. The treatment of this condition, especially when chronic, should be based on a multimodal rehabilitation approach tailored to the patients’ needs and expectations [ 6 , 10 , 11 , 12 ]. This approach entails non-surgical treatments such as therapeutic exercise and patient education, as first-line intervention treatments, combined with acceptance and commitment therapy, manual therapy, and drug therapy (antidepressants and other drugs acting on central sensitisation processes), as conditional treatments, when appropriate [ 6 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of this condition, especially when chronic, should be based on a multimodal rehabilitation approach tailored to the patients’ needs and expectations [ 6 , 10 , 11 , 12 ]. This approach entails non-surgical treatments such as therapeutic exercise and patient education, as first-line intervention treatments, combined with acceptance and commitment therapy, manual therapy, and drug therapy (antidepressants and other drugs acting on central sensitisation processes), as conditional treatments, when appropriate [ 6 , 10 , 11 , 12 ]. However, the management of MSK pain conditions is complex and often presents challenges in the classification and diagnosis of these conditions, an overuse of surgery, and a low percentage of patients getting the proper care and education they should receive [ 6 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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The Use of Botulinum Toxin A as an Adjunctive Therapy in the Management of Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis

Battista

¹

,

Buzzatti

²

,

Gandolfi

³

et al. 2021

Toxins

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Several studies have investigated the effect of botulinum toxin A (BoNT-A) for managing chronic musculoskeletal pain, bringing contrasting results to the forefront. Thus far, however, there has been no synthesis of evidence on the effect of BoNT-A as an adjunctive treatment within a multimodal approach. Hence, Medline via PubMed, EMBASE, and the Cochrane Library-CENTRAL were searched until November 2020 for randomised controlled trials (RCTs) that investigated the use of BoNT-A as an adjunctive therapy for chronic musculoskeletal pain. The risk of bias (RoB) and the overall quality of the studies were assessed through RoB 2.0 and the GRADE approach, respectively. Meta-analysis was conducted to analyse the pooled results of the six included RCTs. Four were at a low RoB, while two were at a high RoB. The meta-analysis showed that BoNT-A as an adjunctive therapy did not significantly decrease pain compared to the sole use of traditional treatment (SDM −0.89; 95% CI −1.91; 0.12; p = 0.08). Caution should be used when interpreting such results, since the studies displayed very high heterogeneity (I = 94%, p < 0.001). The overall certainty of the evidence was very low. The data retrieved from this systematic review do not support the use of BoNT-A as an adjunctive therapy in treating chronic musculoskeletal pain.

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“…Most MSK patients have to live with pain for a long duration, and the continuous physical suffering and social stigmatization from MSK pain decrease their quality of life [ 5 ]. Chronic MSK pain is also often accompanied by mental health problems, such as depression, anxiety, emotional regulation problems, and sleep disorders, as well as impaired cognitive function (e.g., decreased inhibitory control, memory and, in particular, emotion-related ability), which might impair social function [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

Zhang

¹

,

Ou

²

,

Meng

³

et al. 2021

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Background. In recent years, a growing number of researchers showed significant interest in psychological and social interventions to manage chronic musculoskeletal (MSK) pain. Cognitive and emotional empathy is an attractive and valuable sociopsychological factor that may provide protection and resilience against chronic MSK pain. However, its effect on outpatients remains underexplored. Objective. To compare the empathy ability between chronic MSK pain outpatients and healthy controls and explore the relationship between cognitive/emotional empathy and chronic pain. Methods. Patients with chronic MSK pain ( n = 22 ) and healthy controls ( n = 26 ) completed the pain assessment and empathy ability task, utilizing a multidimensional empathy assessment tool with satisfactory reliability and validity (i.e., the Chinese version of the Multifaceted Empathy Test (MET-C)). Results. The data indicated that the chronic MSK pain outpatients had impaired cognitive empathy (i.e., lower squared cognitive empathy accuracy: Student’s t = − 2.119 , P = 0.040 , and longer task completion time: Student’s t = 3.382 , P = 0.002 ) compared to healthy controls, and cognitive empathy was negatively correlated with pain intensity ( r = − 0.614 , P = 0.002 ). Further, the impaired cognitive empathy was present in identifying positive, but not negative emotions. Conclusion. These results indicate that chronic MSK pain is associated with impaired empathy ability. Our studies contribute to offering a potential direction for developing psychosocial interventions to treat chronic MSK pain.

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

Cited by 227 publications

References 108 publications

A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

The Use of Botulinum Toxin A as an Adjunctive Therapy in the Management of Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis

Impaired Cognitive Empathy in Outpatients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

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