Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)

Clauw, Daniel J.

doi:10.1016/j.berh.2015.04.024

Cited by 169Pain Mechanisms and TreatmentsMusculoskeletal pain and rehabilitationPain Management and Treatment

Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)

Clauw, Daniel J.·2015·Best Practice & Research Clinical Rheumatology

DOI 10.1016/j.berh.2015.04.024

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Abstract

Until recently, most clinicians considered chronic pain to be typically due to ongoing peripheral nociceptive input (i.e., damage or inflammation) in the region of the body where the individual is experiencing pain. Clinicians are generally aware of a few types of pain (e.g., headache and phantom limb pain) where chronic pain is not due to such causes, but most do not realize there is not a single chronic pain state where any radiographic, surgical, or pathological description of peripheral nociceptive damage has been reproducibly shown to be related to the presence or severity of pain. The primary reason for this appears to be that both the peripheral and central nervous systems play a critical role in determining which nociceptive input being detected by sensory nerves in the peripheral tissues will lead to the perception of pain in humans. This manuscript reviews some of the latest findings regarding the neural processing of pain, with a special focus on how clinicians can use information gleaned from the history and physical examination to assess which mechanisms are most likely to be responsible for pain in a given individual, and tailors therapy appropriately. A critical construct is that, within any specific diagnostic category (e.g., fibromyalgia (FM), osteoarthritis (OA), and chronic low back pain (CLBP) are specifically reviewed), individual patients may have markedly different peripheral/nociceptive and neural contributions to their pain. Thus, just as low back pain has long been acknowledged to have multiple potential mechanisms, so also is this true of all chronic pain states, wherein some individuals will have pain primarily due to peripheral nociceptive input, whereas in others peripheral (e.g., peripheral sensitization) or central nervous system factors ("central sensitization" or "centralization" of pain via augmented pain processing in spinal and brain) may be playing an equally or even more prominent role in their pain and other symptoms.

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FM is considered an unresolvable primary chronic pain condition wherein evaluations of affective pain appear to be more susceptible to change after intervention than general evaluations of pain that include permanent sensory symptoms.
“FM is considered an unresolvable primary chronic pain condition wherein evaluations of affective pain appear to be more susceptible to change after intervention than general evaluations of pain that include permanent sensory symptoms (Clauw, 2015, Wolfe et al., 1990, Wolfe et al., 2010).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Clauw, 2015

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“FM is considered an unresolvable primary chronic pain condition wherein evaluations of affective pain appear to be more susceptible to change after intervention than general evaluations of pain that include permanent sensory symptoms (Clauw, 2015, Wolfe et al., 1990, 2010).”
Background

Authors: Clauw, D. J.
Affiliations: University of Michigan (US)
Corresponding author: Clauw, Daniel J.
ORCID: Clauw, Daniel J.
Venue: Best Practice & Research Clinical Rheumatology
Publisher: Elsevier BV
Published: 2015-02
Volume: 29
Issue: 1
Pages: 6-19
ISSN: 1521-6942 (ISSN-L)
DOI: 10.1016/j.berh.2015.04.024
OpenAlex: W1951621994
Cited by: 169
References: 100
Citations by year: 2026: 17 · 2025: 15 · 2024: 8 · 2023: 7 · 2022: 23 · 2021: 16 · 2020: 16 · 2019: 17 · 2018: 18 · 2017: 16 · 2016: 16
FWCI: 2.04
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Best Practice & Research Clinical Rheumatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: chronic musculoskeletal pain, pain mechanisms, central sensitization, peripheral sensitization, fibromyalgia, osteoarthritis, chronic low back pain, pain diagnosis, pain management, nociception
MeSH terms: Humans, Pain Perception, Central Nervous System Sensitization, Chronic Pain, Musculoskeletal Pain

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Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s)

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