Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 9;7(5):e1024.
doi: 10.1097/PR9.0000000000001024. eCollection 2022 Sep-Oct.

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

Mary-Ann Fitzcharles  1   2 , Steven P Cohen  3   4 , Daniel J Clauw  5 , Geoffrey Littlejohn  6 , Chie Usui  7 , Winfried Häuser  8   9
Affiliations

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

Mary-Ann Fitzcharles et al. Pain Rep. .

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.

PubMed Disclaimer

Conflict of interest statement

S.P. Cohen is supported by a grant from the U.S. Dept. of Defense, Uniformed Services University, Department of Physical Medicine & Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness (MIRROR) (HU00011920011). S.P. Cohen has consulted for Avanos, Persica, SPR, and Scilex/Sorrento. D.J. Clauw has performed consulting for Pfizer, Tonix, Samumed, Lilly, and Aptinyx and has received research funding from Aptinyx. M.-A. Fitzcharles and SP Cohen contributed equally to this article. All authors participated in the writing of this manuscript. The remaining authors have no conflicts of interest to declare.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

References

    1. Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, Martin SA. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns 2008;73:114–20. - PMC - PubMed
    1. Asbring P, Närvänen AL. Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia. Qual Health Res 2002;12:148–60. - PubMed
    1. Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 2021;9:2077–89. - PMC - PubMed
    1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014;311:1547–55. - PubMed
    1. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet 2021;397:2082–97. - PubMed