Intended for healthcare professionals

Practice ABC of Pain

Chronic Musculoskeletal Pain

BMJ 2013; 346 doi: (Published 24 May 2013) Cite this as: BMJ 2013;346:bmj.f3146
  1. Paul Dieppe
  1. Peninsula College of Medicine and Dentistry, Exeter, UK

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  • The majority of chronic pain experienced by older adults is musculoskeletal in origin

  • The symptom experience and impact of this pain varies greatly

  • Chronic musculoskeletal pain is often associated with reduced activity, sleep disturbance, fatigue and mood alterations, and can result in severe disability

  • Regional pain in a single joint area is very common. It may be referred from above, or be due to periarticular lesions, as well as arthritis. A good history and careful examination should result in an accurate diagnosis

  • There are two main forms of arthritis: osteoarthritis (OA) and inflammatory arthritis. Pain in OA does not correlate well with pathology, is largely ‘mechanical’ in nature, and is difficult to treat. The pain of inflammatory arthritis is associated with severe joint stiffness and responds well to anti-inflammatory therapy

  • Generalised musculoskeletal pain in the absence of peripheral pathology (‘fibromyalgia’) is also common. There is evidence that this condition is due to pain sensitisation and loss of the normal inhibitory mechanisms that help reduce pain


Musculoskeletal pain is ubiquitous – everyone gets it. There are three main causes:

  1. everyday activities that put unusual or repetitive strains on the system;

  2. acute traumatic events;

  3. musculoskeletal diseases.

Everyone is familiar with the aches and pains that generally follow unaccustomed activity and most of us will have had at least one episode of acute post-traumatic pain affecting our muscles, bones or joints. These problems are generally short lasting and not very bothersome. However, huge numbers of us, particularly older adults, also experience chronic, intrusive musculoskeletal pain. …

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