Musculoskeletal Pain

Musculoskeletal pain is pain arising from the bones, joints, muscles, tendons, ligaments, and related soft tissues. It is extremely common, encompasses conditions from low back and neck pain to osteoarthritis-related and widespread pain such as fibromyalgia, and is collectively the leading contributor to disability worldwide.

Definition

Musculoskeletal pain is pain that originates from structures of the musculoskeletal system — bones, joints, muscles, tendons, ligaments, and associated soft tissues — and ranges from localised regional pain, such as low back pain, to chronic widespread pain.

Scope

This topic covers what musculoskeletal pain is, the range of conditions it includes, the mechanisms that produce nociceptive and nociplastic musculoskeletal pain, and its standing as a major cause of global disability. It is a reference overview and does not provide treatment recommendations.

Key concepts

• Regional pain (e.g., low back and neck pain)
• Osteoarthritis-related joint pain
• Chronic widespread pain and fibromyalgia
• Nociceptive vs nociplastic mechanisms
• Non-specific low back pain
• Biopsychosocial contributors and disability

Mechanisms

Much musculoskeletal pain is nociceptive, arising from activation of pain receptors in inflamed, degenerating, or mechanically stressed tissues such as joints affected by osteoarthritis. In many common presentations, however — including most non-specific low back pain — a precise structural cause cannot be identified, and pain reflects an interaction of tissue, neurophysiological, psychological, and social factors. In conditions such as fibromyalgia, altered central pain processing (nociplastic pain) with central sensitisation is thought to predominate, producing widespread pain and tenderness without proportionate tissue damage.

Clinical relevance

Musculoskeletal conditions, led by low back pain, are the foremost cause of years lived with disability globally, so understanding how this pain is categorised matters across primary care, rheumatology, and rehabilitation. This entry is reference material describing the syndromes and their mechanisms; it notes that most low back pain is non-specific and self-limiting but does not provide individualised diagnostic or treatment advice.

Epidemiology

Musculoskeletal pain is among the most prevalent of all health complaints, and low back pain in particular is consistently identified as the single leading cause of disability worldwide, with high lifetime prevalence across populations and rising burden with population ageing.

History

Regional pains such as back pain have been recorded throughout medical history, but the recognition of musculoskeletal pain as a leading driver of global disability is a more recent development, supported by the Global Burden of Disease studies. Parallel work reframed much chronic musculoskeletal pain, especially non-specific back pain and fibromyalgia, in biopsychosocial and nociplastic terms rather than as purely structural disorders, and chronic musculoskeletal pain was incorporated into the ICD-11 chronic pain classification.

Debates

How much of chronic musculoskeletal pain is structural?

For common conditions such as non-specific low back pain, imaging findings often correlate poorly with symptoms, and a purely structural model has given way to a biopsychosocial understanding in which psychological and social factors substantially shape pain and disability.

Key figures

• Jan Hartvigsen
• Gary Macfarlane
• Steven Cohen

Seminal works

• hartvigsen-2018
• macfarlane-2017

Frequently asked questions

Is most low back pain due to a specific structural problem?

No. The large majority of low back pain is classified as non-specific, meaning no precise structural or pathological cause can be identified, and it is best understood through a biopsychosocial model.

Is fibromyalgia a type of musculoskeletal pain?

Fibromyalgia presents as chronic widespread musculoskeletal pain, but it is understood as a nociplastic condition involving altered central pain processing rather than ongoing tissue or joint damage.