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Introduction
Musculoskeletal conditions impact the health and wellbeing of a number of people. These condition can affect joints, bones, muscles and sometimes associated tissues, such as nerves. Musculoskeletal conditions can range from minor injuries to long-term conditions.
Over 20 million people in the UK - equivalent to one-third of the population - have musculoskeletal conditions. Musculoskeletal conditions can affect a person’s quality of life and independence (Versus Arthritis 2022). The most common causes of pain and disability are low back pain, neck pain and osteoarthritis.
Many adults will experience one or more episodes of musculoskeletal pain at some point in their lives, irrespective of age, gender or economic status. Older people are more likely to experience chronic musculoskeletal pain. As a person ages, joints can deteriorate, muscles weaken and lifestyles often become more sedentary, all of which contribute to musculoskeletal pain. While age is an important risk factor, musculoskeletal pain can
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Definition
Arthritis
Arthritis is a condition that causes pain and inflammation in the joint. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is the most common type of arthritis in the UK, and often develops in people in their mid-40s or older. It is more common in women and people with a family history of the condition. Osteoarthritis predominantly affects the smooth cartilage lining of the joint, making movement more difficult, leading to pain and stiffness. When the cartilage lining begins to roughen and thin out, tendons and ligaments need to work harder, resulting in swelling and the formation of bony spurs known as osteophytes. If there is significant loss of cartilage, bone will rub on bone, causing the joint to change shape, forcing the bones out of their normal position. The most commonly affected joints are those in the hands, spine, knees and hips.
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Symptoms
Pain is the most common presenting symptom of musculoskeletal disorders, and can be severe and intense. Regional pain of a single joint is common (Dieppe, 2013), and particular postures or movements can exacerbate or relieve the pain.
Body aches, pain and stiffness are common for many patients. Joint stiffness and aches are often worst when waking or after a period of inactivity. Joints may ‘loosen up’ throughout the day as the person starts to mobilise. While exercise can improve range of motion, mobility and reduce pain, people should take care not to overuse or injure muscles and joints.
Patients with musculoskeletal pain may report that they cannot find a comfortable position for sleep and may try sleeping in reclining chairs or while sitting up, which further worsens fatigue (Dieppe 2013).
Chronic musculoskeletal disorders can also have a neuropathic component. This type of pain is often felt as sensations of
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Diagnosis
Patient symptoms and history, physical examination and, in some instances, radiological images can help diagnose an underlying condition or pain syndrome. Patients often report pain (usually in a specific area), fatigue and sleep disruptions as a result of pain. Patients are usually able to identify the injury that has caused the pain.
The history should include general medical history, history of the current illness and associated comorbidity, along with previous similar attacks and the results of any diagnostic tests. The clinician must also consider previous or current therapy, including use of medication and its effects. Physical examination includes a general examination, neurological and musculoskeletal examinations noting any sensory, motor, autonomic changes and the presence of deformity.
Assessment will also include changes in occupational ability and the impact of previous treatments on the patient’s ability to perform routine activities.
Pain assessment
The clinician should identify pain type, severity,
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Treatment
Managing a patient’s pain involves a combination of pharmacological and non-pharmacological interventions. For patients with chronic musculoskeletal pain, non-pharmacological treatments, such as therapeutic exercises and multidisciplinary rehabilitation care packages, are used first (Table 1).
| Table 1. Examples of non-pharmacological treatment | |
|
Non-pharmacological treatment |
Description |
| Therapeutic exercise | Offer exercise tailored to need, consider referral to physiotherapist. Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise |
| Weight management |
For those with osteoarthritis who are overweight or obese. Weight loss will improve quality of life and physical function and reduce pain. Provide support to choose a weight loss goal. Explain that any amount of weight loss is beneficial |
| Manual therapy |
Only consider manual therapy (eg manipulation, mobilisation or soft tissue techniques): - for people with hip or knee osteoarthritis and - alongside therapeutic exercise |
| Devices | Consider walking aids (eg walking sticks) for those with lower limb osteoarthritis. Referral to occupational therapist should be considered. |
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Resources
Cox F. Basic principles of pain management: assessment and intervention. Nurs Stand. 2010;25(1):36-39. https://doi.org/10.7748/ns2010.09.25.1.36.c7983
Dieppe P. Chronic musculoskeletal pain. BMJ. 2013;346:f3146. https://doi.org/10.1136/bmj.f3146
Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1(3):277-299. https://doi.org/10.1016/0304-3959(75)90044-5
National Institute for Health and Care Excellence (NICE). 2022. Osteoarthritis in Over 16s: Diagnosis and Management. https://www.nice.org.uk/guidance/ng226 (accessed 6 April 2023)
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(7):514-530. https://doi.org/10.7326/M16-2367
Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. https://doi.org/10.1097/j.pain.0000000000001939
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