Pain hurts — and it is often the factor that compels an individual to seek medical care. Estimates of the annual cost of health care due to pain ranges from $560 billion to $635 billion (in 2010 dollars) in the USA.Citation1 Furthermore, chronic musculoskeletal disorders constitute a major portion of painful medical conditions.Citation2 It is perhaps not surprising that researchers have proposed diagnosis in terms of pain mechanism, suggesting that treatment should be directed at the specific neurophysiologic mechanism at fault.Citation3
In this special issue on musculoskeletal pain, Arendt-Nielsen and Graven-NielsenCitation4 focus on a major hurdle in pain science: the identification of biomarkers that signal the transition from acute to chronic pain. These authors describe the nociceptive mechanisms associated with tendon, muscle, bone, and joint pain, and discuss clinical findings, including somatosensory measures, which may correlate with neuroplastic changes of nociceptive pathways. SterlingCitation5 applies these scientific principles to the problem of whiplash associated disorder. It is well known that a significant number of those with whiplash injury will transition from an acute to a chronic pain status.Citation6 Sterling provides evidence for prognostic factors that should be considered following motor vehicle crashes.
Understanding the mechanisms at play in a musculoskeletal disorder is important particularly when it directs treatment. While manual therapies have been demonstrated to modulate pain, how do our treatment methods affect nociceptive mechanisms? de la Llave-Rincon et al.Citation7 and Courtney et al.Citation8 address management of musculoskeletal pain of the upper and lower quadrant, respectively, with particular emphasis on thrust and non-thrust manipulation, while DommerholtCitation9 discusses the use of dry needling, a treatment technique used more and more commonly by health care providers in the USA, and in particular, by physical therapists. The current issue discusses the neurobiological basis behind chronic pain and suggests that management strategies should utilize a combination of applied basic and clinical sciences. The use of manual therapies for treatment of acute and chronic pain appears promising, yet further research is needed to refine our knowledge in this important area of science.
References
- Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education. Relieving pain in America, a blueprint for transforming prevention, care, education and research [document on the Internet]. Atlanta, GA: The National Academies Press, 2011. Available from: http://books.nap.edu/openbook.php?record_id=13172. Web. 5 Jul. 2011.
- National Centers for Health Statistics. Chartbook on trends in the health of Americans 2006, special feature: pain [document on the Internet]. Atlanta, GA: National Centers for Health Statistics. Available from: http://www.cdc.gov/nchs/data/hus/hus06.pdf. Web. 5 Jul. 2011.
- Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd B, Koltzenburg M, et al.. Towards a mechanism-based classification of pain? Pain 1998;77:227–9.
- Arendt-Nielsen L, Fernández-de-las-Peñas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther 2011;19:186–93.
- Sterling M. Whiplash associated disorder: musculoskeletal pain and related clinical findings. J Man Manip Ther 2011;19:194–200.
- Elliott JM, Noteboom JT, Flynn TW, Sterling M. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther 2009;39:312–23.
- de las Llave-Rincon AI, Puentedura EJ, Fernández-de-las-Peñas C. Clinical presentation and manual therapy for upper quadrant musculoskeletal conditions. J Man Manip Ther 2011;19:201–11.
- Courtney CA, Clark JD, Duncombe AM, O’Hearn MA. Clinical presentation and manual therapy for lower quadrant musculoskeletal conditions. J Man Manip Ther 2011;19:212–22.
- Dommerholt J. Dry needling — peripheral and central considerations. J Man Manip Ther 2011;19:233–7.