Review highlights mixed pain phenotypes in musculoskeletal disorders

A Nature Reviews Rheumatology review reports that overlapping pain phenotypes affect more than one-third of people with musculoskeletal conditions. It emphasizes clinical assessment and personalized, biopsychosocial management, particularly when neuropathic or nociplastic components complicate treatment.

Overlapping pain affects more than one-third of people with musculoskeletal conditions.
Identification relies primarily on history-taking and physical examination.
Neuropathic and nociplastic components are associated with less favourable outcomes.
Management emphasizes personalized, multimodal care after optimizing underlying disease treatment.

A review in Nature Reviews Rheumatology examines overlapping nociceptive, neuropathic and nociplastic pain in musculoskeletal disorders, including inflammatory arthritis, osteoarthritis, spinal disorders and soft-tissue conditions. It discusses mechanisms, clinical identification and management rather than reporting a new intervention trial.

The review reports that more than one-third of individuals with musculoskeletal conditions have more than one pain phenotype. Additional pain mechanisms, most commonly nociplastic pain, are associated with greater symptom burden, poorer quality of life and less favourable responses to conventional analgesics and procedures than predominantly nociceptive pain. Central sensitization can contribute to nociplastic pain and may have biological, environmental and psychosocial origins.

Identification relies primarily on history-taking and physical examination because no validated biomarker or widely accessible diagnostic test is available. Quantitative sensory testing and patient-reported questionnaires can provide supporting evidence but remain underused in routine care. After optimizing treatment of the underlying condition, the review advocates personalized, multimodal management incorporating education, self-management, healthy lifestyle behaviours, treatment of relevant comorbidities and cautious pharmacotherapy. Recognition of mixed pain may inform surgical and interventional decisions. The supplied subscription preview does not provide detailed evidence grading or quantitative treatment-effect estimates.

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Nature Reviews Rheumatology: Mixed pain phenotypes in musculoskeletal disorders: mechanisms and management ↗

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