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Musculoskeletal Pain, its Treatments, and Effects on Well-Being

Aurélia Bickler

By Jennifer Brown


Musculoskeletal Pain, its Treatments, and Effects on Well-Being

The most common type of chronic pain is chronic musculoskeletal pain (CMP), or persistent or recurrent pain within the musculoskeletal system that lasts at least three months (Zhuang et al., 2022). Chronic musculoskeletal pain is often described as pain in joints, neck and shoulder, low back, limb, spine, and widespread pain through fibromyalgia and myofascitis (Zhuang et al., 2022). College students are at increased risk of CMPs, depending upon their activity level, past medical history, posture, and ergonomics. That said, to avoid worsening any current bodily pain and discomfort, schools must provide resources for students to utilize. Thus, the following discussion briefly covers prevention measures, self-assessments for musculoskeletal pain and discomfort, what the process is to get diagnosed with CMPs, standard treatments for CMPs, complementary and alternative measures for CMPs, and how psychological treatments for CMPs work and help improve quality of life and well-being.


Preventative measures to avoid chronic musculoskeletal pain

According to Lewis et al. (2019), arthritis and musculoskeletal disorders contribute to disability and morbidity on a global spectrum. Lewis et al. (2019) condensed the findings from the international workshop "Musculoskeletal Health in the 21st Century” to assist with prevention measures within their narrative review done in 2019. The following is part of the information taught at the workshop.


Interventions for common musculoskeletal conditions

Per Lewis et al. (2019), low back and neck pain, falls, and osteoarthritis are common musculoskeletal conditions among English individuals. Researchers note the following interventions for these conditions: low back and neck pain-staying physically active, regular exercise (suggested within a group exercise program), and weight-loss support if needed; falls-strength and balance training, home hazard assessments, fall prevention programs, participation in activities like tai chi, dancing, or gardening; osteoarthritis-activity and exercise for muscle strengthening, improving aerobic fitness levels (suggested through walking, swimming, and pilates), and weight loss support, if needed (Lewis et al., 2019).  


Suggested lifestyle changes

The authors also mentioned that increasing physical activity is necessary to reduce the risk of obesity and type-2 diabetes (Lewis et al., 2019). Accordingly, researchers believe that to age healthily; individuals must heed the recommended physical activity levels for one’s age group. For instance, the Centers for Disease Control and Prevention (2021) lists that adults between 18-64 should have at least 150 minutes of moderate-intensity activity and at least two days per week of activities that strengthen muscles. For more information, go to https://www.cdc.gov/physicalactivity/basics/age-chart.html.


Prevention techniques from Australian sonography students

A study completed in Australia studied the effect of musculoskeletal disorder prevention techniques on injury prevention among sonography students. During their studies, students were taught techniques such as adjusting equipment to one's height, stretching, pilates, reducing arm abduction, use of ergonomic aids, taking breaks, and personality risk assessments (Felton et al., 2022). In this study, however, researchers found that risk reduction tends to rely upon whether individuals have developed habits for utilizing preventative techniques (Felton et al., 2022). Specifically, generally, people will utilize nonspecific techniques for injury prevention. However, the use of pilates, postural adjustments and modifications, and personal risk assessments have promise for regular usage. For more information on ergonomics for students, please visit  https://www.crosscountryeducation.com/blogs/ergonomics-for-students.


Self-assessments for musculoskeletal pain and discomfort

Students can often experience musculoskeletal pain, as students tend to have sedentary lifestyles and bodily discomfort due to poor ergonomics and repetitive movements (Alsaadi, 2022). Accordingly, Cornell University (Cornell University Ergonomics Web, n.d.) created a series of musculoskeletal discomfort questionnaires to assess symptoms and pain severity. Cornell University specifically created questionnaires for sedentary and standing workers, those with hand symptoms, and student-specific questionnaires. Developed from Hedge et al.'s (1999) study on the ergonomics of body posture, these questionnaires have shown high face validity and reliability and, thus, can be helpful in students understanding pain and its severity (Cornell University Ergonomics Web, n.d.). To access these questionnaires, Cornell University’s Ergonomics website lists the forms at https://ergo.human.cornell.edu/ahmsquest.html and https://ergo.human.cornell.edu/ahSSCMDQquest.html.


Initial assessments for chronic musculoskeletal pain

According to Zhuang et al. (2022), the International Classification of Diseases (ICD-11) classifies CMP as chronic primary and secondary musculoskeletal pain. The former is defined as chronic pain within muscles, bones, joints, or tendons which is comorbid with significant emotional distress or functional disability, not attributed to known disease or damage (Zhuang et al., 2022). The latter is described as CMP from a known disease, such as persistent local or systemic inflammatory diseases, local musculoskeletal structural changes, or musculoskeletal issues due to neurological disease (Zhuang et al., 2022).

Providers will take a personal health history, examinations, laboratory testing, and other imaging tests to diagnose CMP and ask for initial pain ratings (Zhuang et al., 2022). During the initial evaluation, providers will also identify any factors that can influence symptoms, do a functional assessment, and measure health-related quality of life. Providers will examine gait, posture, balance, and fitness levels to look for signs of mechanical stress (often due to abnormal movement patterns) (Lewis et al., 2019). Additional assessments that may be done include tests for biomarkers (biochemical markers within blood and urine), and central sensitization testing, which involves detecting pain responses within the skin (Lewis et al., 2019; Zhuang et al., 2022).


Common and non-traditional treatments for chronic musculoskeletal pain

Chronic musculoskeletal pain treatment involves getting a proper diagnosis, grade of pain, and improving quality of life. It is common to use pharmaceuticals, over-the-counter pain medications, physical therapy rehabilitation, and additional non-traditional treatments such as acupuncture, chiropractic medicine, and pain-relieving injections to treat everyday pain. Below is a brief discussion regarding these methods of treatment.


Commonly used treatments

CMPs are often treated with medications such as non-opioid analgesics (NSAIDs) and serotonin-noradrenaline reuptake inhibitors (SNRIs), as well as muscle relaxants, ion channel drugs, topical drugs (Lewis et al., 2019; Zhuang et al., 2022). Interestingly, research has shown that dogs can also suffer from CMPs, specifically osteoarthritis (OA). Lewis et al. (2019) describe that treatment for canine species with osteoarthritis, which includes weight control, nutritional and pain management, and physical therapy, has historically had positive results (Lewis et al., 2019). When humans are treated for OA, treatment typically is more complex, including utilizing stronger pain medications, such as opioids, as well as systemic and intraarticular corticosteroids (Lewis et al., 2019). However, providers must consider the whole patient and the side effects following particular treatments. Providers who implement physical therapy, for instance, must ensure that certain conditions are caught early and that the patient can and is willing to do the prescribed exercises.


Non-traditional treatments (complementary and alternative care) for CMP

Regarding non-traditional treatments, patients frequently turn to acupuncture, chiropractic care, massage therapy, and local anesthetic injections. When patients are treated with acupuncture, the needles are placed where bodily energy flows and attempts to alter the pain signals and regulate levels of endorphins and tissue vasodilation (Bhoi et al., 2021). Acupuncture is commonly used to treat chronic back pain, OA of the knee, and fibromyalgia (Bhoi et al., 2021). In the same respect, chiropractic care is commonly used for pain relief. Chiropractic care manipulates the joints and attempts to alter the range of motion to realign the brain and body (Bhoi et al., 2021). Spinal manipulation has been effective for specific conditions such as low back pain and neck pain; however, its effectiveness varies from person to person.


Additional complementary and alternative treatment methods include massage therapy and yoga. Massages, for instance, can increase lymph flow, clear lactate, prevent fibrosis, and even help the immune system (Bhoi et al., 2021). Yoga similarly helps increase blood flow to specific muscles and body parts. However, its postures, breathing techniques, and meditation methods help create a calmer peace of mind and a more flexible and relaxed body (Bhoi et al., 2021). Yoga has also been shown to reduce the disease activity of inflammatory markers, like interleukins and the tumor necrosis factor, which can help improve rheumatoid arthritis (Bhoi et al., 2021).


The research listed by Lewis et al. (2019) suggests that in both veterinary medicine and human medicine, acupuncture, ultrasound, and transcutaneous electrical nerve stimulation have effectively reduced pain. Promising treatments include cryotherapy, laser therapy, topical anesthetics, cannabis-based medications, and immersive virtual reality multimodal therapies (Lewis et al., 2019; Zhuang et al., 2022). Bhoi et al. (2021) likewise mention that regenerative therapy, such as platelet-rich plasma therapy injections, stem cell therapy, and growth factors, shows the potential to help individuals manage pain.


Mental health and well-being and chronic musculoskeletal pain


Chronic pain among college students

There is a multitude of research studies that have found musculoskeletal pain to be correlated with psychological distress and poorer quality of life. In Alsaadi’s (2022) study on musculoskeletal pain among undergraduate students, researchers found that neck and low back pain were standard among half of the students in a university in Saudi Arabia. Specifically, musculoskeletal pain within the past year was significantly associated with more anxiety and reduced sleep quality; interestingly, when the pain was within the past week, students had higher rates of depression (Alsaadi, 2022). Moreover, Alsaadi (2022) also found that anxiety was associated with and predicted pain chronicity. Researchers suggest that students may have more predispositions to stress in college settings.


Mind-body therapies

Accordingly, results such as these indicate that there must be more on-campus and virtual resources for pain reduction among student populations. Modern-day mind-body therapies have recently been shown to be helpful in pain reduction. Research from the Bhoi et al. (2021) study indicates that therapies designed for balancing the mind and body ultimately help reduce stress and change the mental and emotional state of the sufferer. Specifically, Tai Chi, biofeedback, guided imagery, progressive muscle relaxation, cognitive behavioral therapy, and even hypnosis have had positive results in helping manage backache, fibromyalgia, and general musculoskeletal pain (Bhoi et al., 2021).


How psychological methods work to reduce pain

Per Murillo et al. (2022), psychological interventions aim to address various pain-specific psychosocial constructs theorized to be associated with changes in functioning due to pain. In their study, Murillo et al. (2022) combed through several studies to understand the underlying mechanisms of psychological pain reduction methods. Researchers discovered that pain reduction therapies utilize pain reduction-related fears and catastrophic thinking and increase self-efficacy (Murillo et al., 2022). Specifically, aiming to increase one's understanding of control in life helps to widen tolerability to pain.


Moreover, researchers found that among cognitive behavioral therapies (CBT) and acceptance and commitment therapies (ACT), providers use complex methods which utilize more than one construct, often focusing on pain-specific psychosocial constructs (Murillo et al., 2022). In other words, CBT tends to reduce disability related to pain by improving pain management via increasing self-efficacy levels. However, these techniques still need more research on how to reduce pain intensity. Similarly, research on ACT has found that this therapy focuses more on enhancing pain acceptance and increasing psychological flexibility, or how individuals regulate emotions and make decisions based on values and long-standing beliefs vs. immediate short-term emotions (Murillo et al., 2022). Some of the methods ACT uses include utilizing the components within the psychological flexibility model, such as acceptance, values-based action, and present-focused awareness (Murillo et al., 2022). In the same way, mindfulness-based treatments also aim to reshape beliefs about pain and the overall experience of pain.


Summary

In summary, chronic musculoskeletal pain involves several processes, treatment and management techniques, and individual factors to consider when someone suffers from chronic pain. While this is a brief overview of CMPs, it is essential to follow up with medical professionals if pain continues, changes, or affects the quality of life. For more information, please visit National University's healthcare plans and services and NU's mental health resources and wellness plans via the whole person center and the Timely Care. 

           

References

Alsaadi, S. M. (2022). Musculoskeletal pain in undergraduate students is significantly associated with psychological distress and poor sleep quality. International Journal of Environmental Research Public Health, 16(21), 1-11. https://doi.org/10.3390/ijerph192113929


Bhoi, D., Jain, D., Garg, R., Iyengar, K. P., Hoda, W., Vaishya, R., & Jain, V. K. (2021). Complementary and alternative modalities (CAM) for pain management in Musculoskeletal diseases (MSDs). Journal of Clinical Orthopedics and Trauma, 18, 171-180. https://doi.org/10.1016/j.jcot.2021.04.02


Centers for Disease Control and Prevention. (2021). Physical activity for different groups. Retrieved from https://www.cdc.gov/physicalactivity/basics/age-chart.html


Cross Country Education. (2023). School OT resources: Ergonomics for students. https://www.crosscountryeducation.com/blogs/ergonomics-for-students


Felton, J. L., Kennedy, N., Thoirs, K., Alphonse, J., & Quinton, A. E. (2022). Knowledge and use of work-related musculoskeletal disorder (WRMSD) prevention techniques in the daily practice of final-year Australian sonography students: A cross-sectional study. Sonography, 10(1), 3-9. https://doi.org/10.1002/sono.12334


Lewis, R., Gomez Alvarez, C. B., Rayman, M., Lanham-New, S., Woolf, A., & Mobasheri, A. (2019). Strategies for optimizing musculoskeletal health in the 21st century. BMC Musculoskeletal Disorders, 20(164), 1–15. https://doi.org/10.1186/s12890-019-2510-7


Murillo, C., Vo, T. T., Vansteelandt, S., Harrison, L. E., Cagnie, B., Coppieters, I., Chys, M., Timmers, I. & Meeus, M. (2022). How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment. Clinical Psychology Review, 94, 102160. https://doi.org/10.1016/j.cpr.2022.102160


Zhuang, J., Houlihan, M., Fang, F., & Ma, X. (2022). What is new in classification, diagnosis, and management of chronic musculoskeletal pain: A narrative review. Frontiers in Pain Research, 3. https://doi.org/10.3389/fpain.2022.937004

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