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musculoskeletal pain

Pain originating from the musculoskeletal system, affecting muscle, ligaments, tendons, & bones. See more specific terms: myalgia, myofascial pain, bone pain. Etiology: 1) trauma a) jerking movements b) accidents, auto accidents c) falls d) fractures e) sprains f) dislocations g) blunt muscle trauma 2) postural strain 3) repetitive movements, overuse 4) prolonged immobilization 5) poor body mechanics 6) medications (see myalgia) Clinical manifestations: 1) variable 2) most common a) pain b) fatigue c) sleep disturbance Laboratory: see specific etiology Radiology: see specific radiology Differential diagnosis: somatoform pain disorder Management: 1) see specific etiology 2) general a) RICED: rest, ice, compression, elevation, drugs (analgesics, NSAIDS) - topical NSAIDs, with or without menthol 1st-line treatment for acute pain from musculoskeletal injury (excepting low-back pain) [5] - acetaminophen noninferior to diclofenac alone or to diclofenac plus acetaminophen in reducing acute minor musculoskeletal pain [3] - ibuprofen & opioids similarly effective for short-term relief of acute extremity pain when combined with acetaminophen [4] b) muscle strengthening & stretching c) physical therapy or occupational therapy d) acupuncture or acupressure [5] e) transcutaneous electrical nerve stimulation (TENS) to reduce pain [5] f) relaxation/biofeedback techniques g) steopathic manipulation h) chiropractic care i) therapeutic massage 3) walking may be beneficial but long-term effectiveness is uncertain [2] 4) SNRI of marginal benefit for musculoskeletal pain, other antidepressants less useful [6] 5) treatment of insomnia [7]

Related

somatoform pain disorder (psychogenic pain, psychalgia)

Specific

arthralgia bone pain chronic musculoskeletal pain myalgia (muscle pain) myofascial pain

General

musculoskeletal sign/symptom pain [odyn-]

References

  1. WebMD: Pain Management: Musculoskeletal Pain http://www.webmd.com/pain-management/guide/musculoskeletal-pain
  2. O'Connor SR, Tully MA, Ryan B, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96:724-734 PMID: 25529265
  3. Ridderikhof ML, Lirk P, Goddijn H et al. Acetaminophen or nonsteroidal anti-inflammatory drugs in acute musculoskeletal trauma: A multicenter, double-blind, randomized, clinical trial. Ann Emerg Med 2017 Oct 13 PMID: 29033294 http://www.annemergmed.com/article/S0196-0644(17)31506-8/fulltext
  4. Chang AK, Bijur PE, Esses D et al Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. A Randomized Clinical Trial. JAMA. 2017;318(17):1661-1667 PMID: 29114833 https://jamanetwork.com/journals/jama/article-abstract/2661581 - Kyriacou DN Opioid vs Nonopioid Acute Pain Management in the Emergency Department. JAMA. 2017;318(17):1655-1656 PMID: 29114813 https://jamanetwork.com/journals/jama/article-abstract/2661559
  5. Qaseem A, McLean RM, O'Gurek D et al Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. August 18, 2020 PMID: 32805126 https://www.acpjournals.org/doi/10.7326/M19-3602 - Busse JW, Sadeghirad B et al Management of Acute Pain From Non-Low Back Musculoskeletal Injuries A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med. August 18, 2020 PMID: 32805127 https://www.acpjournals.org/doi/10.7326/M19-3601
  6. Anderson P Little Help, Possible Harm of Antidepressants for Musculoskeletal Pain. Medscape - Jan 22, 2021. https://www.medscape.com/viewarticle/944532 - Ferreira GE, McLachlan AJ, Lin CWC et al Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. BMJ 2021;372:m4825 PMID: 33472813 Free article https://www.bmj.com/content/372/bmj.m4825
  7. Adogwa O, Reid MC, Chilakapati S, Makris UE Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain. J Am Geriatr Soc. 2023 Aug;71(8):2373-2380 PMID: 37186060 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.18369