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

doi:10.1097/PR9.0000000000001024

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

Pain Rep. 2022 Aug 9;7(5):e1024. doi: 10.1097/PR9.0000000000001024. eCollection 2022 Sep-Oct.

Authors

Mary-Ann Fitzcharles^{1

2}, Steven P Cohen^{3

4}, Daniel J Clauw⁵, Geoffrey Littlejohn⁶, Chie Usui⁷, Winfried Häuser^{8

9}

Affiliations

¹ Department of Rheumatology, McGill University, Montreal, QC, Canada.
² Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada.
³ Department of Anesthesiology and Critical Care Medicine, Neurology, Physical Medicine and Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁵ Departments of Anesthesiology, Medicine (Rheumatology), and Psychiatry, Chronic Pain and Fatigue Research Center, the University of Michigan Medical School, Ann Arbor, MI, USA.
⁶ Departments of Rheumatology and Medicine, Monash Health and Monash University, Clayton, Australia.
⁷ Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan.
⁸ Department Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany.
⁹ Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany.

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.