Management of Musculoskeletal Pain

Abstract

Acute musculoskeletal pain is a common presenting complaint among patients and is often the first symptom of an operative pathology. Pain is a subjective sensation and an emotional response involving a complex series of pathways from nociception at the site of injury to registration in the cerebral cortex. Measurement of pain is largely subjective, but may be guided by a variety of validated and effective tools. The treatment of acute pain, which relied heavily on opioids in the past, is now understood to be more safely and effectively treated with a combination of multimodal analgesics and non-pharmacologic therapy, including psychological assessment and treatment. Opioids remain an important component of therapy, but their benefits must be weighed against their significant side-effect profile, risk of dependence, diversion, and subsequent addiction. The current opioid epidemic constitutes a national emergency and is associated with astronomical costs, both economically and in human lives. Efforts by physicians to better understand acute musculoskeletal pain and its appropriate treatment regimens are critical in order to provide safe and compassionate care while lessening the broad impact of opioid dependence, addiction, and opioid-related deaths.