Chronic primary musculoskeletal pain: a new concept of nonstructural regional pain

Mary-Ann Fitzcharles, Steven P Cohen, Daniel J Clauw, Geoffrey Littlejohn, Chie Usui, Winfried Häuser, Mary-Ann Fitzcharles, Steven P Cohen, Daniel J Clauw, Geoffrey Littlejohn, Chie Usui, Winfried Häuser

Abstract

The concept that a regional musculoskeletal pain may occur in the absence of identifiable tissue abnormality may be puzzling. Previously these regional complaints were generally categorized as myofascial pain syndromes, or prior to the formalization of the nociplastic pain concept, as musculoskeletal pain with a neuropathic component, and treatments were anatomically focussed. Chronic primary musculoskeletal pain is now identified under the chronic primary pain stem category with the mechanistic descriptor of nociplastic pain. It is possible that many patients previously diagnosed with myofascial pain do in fact suffer from chronic primary musculoskeletal pain, requiring a paradigm shift in management towards more centrally directed treatment strategies. Many questions remain, including validation of the proposed examination techniques, prevalence, ideal treatment, and uptake and acceptance by the healthcare community. This new classification should be welcomed as an explanation for regional pain conditions that previously responded poorly to physically focussed treatments.

Keywords: Chronic; Musculoskeletal; Pain; Primary.

Conflict of interest statement

S.P. Cohen is supported by a grant from the U.S. Dept. of Defense, Uniformed Services University, Department of Physical Medicine & Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) (HU00011920011). S.P. Cohen has consulted for Avanos, Persica, SPR, and Scilex/Sorrento. D.J. Clauw has performed consulting for Pfizer, Tonix, Samumed, Lilly, and Aptinyx and has received research funding from Aptinyx. M.-A. Fitzcharles and SP Cohen contributed equally to this article. All authors participated in the writing of this manuscript. The remaining authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

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