Chronic musculoskeletal pain: pathogenesis, clinical features, therapy possibilities

Abstract

The control of musculoskeletal pain (MSP) is an important part of the complex treatment of rheumatic diseases (RD). Analgesic therapy still plays the leading role in osteoarthritis (OA) and chronic nonspecific back pain (most cases of this syndrome are associated with spinal OA) treatment. Despite the use of modern basic anti-inflammatory drugs (including biological and JAK inhibitors), the problem of MSP control remains relevant in immuno-inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis. The pathogenesis of MSP is complex and closely related to the processes of damage, inflammation and degeneration. A fundamental role here belongs to local and systemic inflammatory response occurrence, which largely determines such elements of the pathogenesis of chronic MSP as peripheral and central sensitization. Depending on the prevailing pathogenesis mechanisms, MSP can manifest itself in several phenotypes: «inflammatory», «mechanical», «enthesopathic», associated with central sensitization. A combination with such symptoms as stiffness, fatigue, muscle tension, sleep disturbance, depression and anxiety is characteristic for MSP. The control should be comprehensive and must include the use of both drug and drug-free preparations. Nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressants and anticonvulsants, local injection therapy (glucocorticoids, hyaluronic acid, platelet-rich plasma), as well as methods of physiotherapy and rehabilitation are used in pain treatment.