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. 2024 Feb 1;59(2):e160-e171.
doi: 10.1055/s-0043-1776135. eCollection 2024 Apr.

Update on Musculoskeletal Pain Management

André Wan Wen Tsai  1 , Ricardo Kobayashi  2 , Ibrahim Afrânio Willi Liu  3 , Márcio Fim  4 , André Cicone Liggieri  2 , Edilson Silva Machado  5
Affiliations

Update on Musculoskeletal Pain Management

André Wan Wen Tsai et al. Rev Bras Ortop (Sao Paulo). .

Abstract

Pain is the most common complaint reported to orthopedists in the outpatient clinic, emergency room, or booth. Numerous publications report the inadequate management of both acute and chronic pain by health professionals. This updated article aims to provide information about musculoskeletal pain, its classification, evaluation, diagnosis, and the multimodal therapeutic approach for each case. For acute pain, adequate control allows for earlier rehabilitation to work and reduces the rates of pain chronification. For chronic pain, the goal is to reduce its intensity and improve the quality of life. Currently, some procedures are increasingly used and aided by imaging tests for diagnostic and therapeutic purposes.

Keywords: acute pain; chronic pain; musculoskeletal pain; pain management; postoperative pain.

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Conflict of interest statement

Conflitos de Interesse Os autores declaram não haver conflito de interesses.

Figures

Fig. 1
Fig. 1
CID-11 classification of chronic pain.
Fig. 2
Fig. 2
Subdivision of chronic pain syndromes per CID-11.
Fig. 3
Fig. 3
Guidelines from the 2020 French recommendations for neuropathic pain treatment.
Fig. 4
Fig. 4
Adaptation of the WHO analgesic ladder for stepped analgesia. Medications in the first step are indicated for mild pain; those in the second step are used for moderate pain, and those in the third step treat severe pain. Later, a fourth step was added to the original ladder to address drug treatment-refractory pain. .
Fig. 5
Fig. 5
Opioid classification per potency and mechanism of action.
Fig. 6
Fig. 6
First- and second-line medications nociceptive pain treatment. a Number of treatments to achieve 50% pain relief with a 95% confidence interval (82-86).
Fig. 7
Fig. 7
Differences between the gabapentinoid drugs available in Brazil.
Fig. 1
Fig. 1
Classificação CID-11 para dor crônica.
Fig. 2
Fig. 2
Subdivisão das síndromes dolorosas crônicas de acordo com o CID-11.
Fig. 3
Fig. 3
Guideline de recomendações francesas de 2020 para o tratamento da dor neuropática.
Fig. 4
Fig. 4
Adaptação da escada analgésica da OMS, baseada na analgesia por degraus. As medicações do primeiro degrau são indicadas para dor leve, do segundo para dor moderada e o terceiro para dor intensa a forte. Posteriormente o quarto degrau foi adicionado a escada original para abordar as dores refratárias ao tratamento medicamentoso.
Fig. 5
Fig. 5
Classificação dos opioides quanto à potência e mecanismo de ação.
Fig. 6
Fig. 6
Medicações de primeira e segunda linhas para o tratamento da DN. a Número de tratamentos para conseguir 50% de alívio da dor com intervalo de confiança de 95% (82-86)
Fig. 7
Fig. 7
Diferenças entre as drogas gabapentinoides disponíveis no Brasil.
See this image and copyright information in PMC

References

    1. Rice A SC, Smith B H, Blyth F M. Pain and the global burden of disease. Pain. 2016;157(04):791–796. - PubMed
    1. Henschke N, Kamper S J, Maher C G. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015;90(01):139–147. - PubMed
    1. Raja S N, Carr D B, Cohen M et al.The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(09):1976–1982. - PMC - PubMed
    1. Chapman C R, Vierck C J. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain. 2017;18(04):3590–3.59E40. - PubMed
    1. Woller S A, Eddinger K A, Corr M, Yaksh T L.An overview of pathways encoding nociception Clin Exp Rheumatol 201735(5, Suppl 107)40–46. - PMC - PubMed