Musculoskeletal conditions affect around 7.3m Australians, and represent a wide range of conditions that impact the function of muscles, bones, joints, tendons, ligaments and connective tissues.
Musculoskeletal (MSK) conditions are both short and long-term in nature; they can arise suddenly, like fractures and sprains, or present as long-term conditions that can last for months or years, like chronic primary lower back pain, arthritis, osteoporosis, osteoarthritis.
These conditions can significantly limit mobility and dexterity. They are large contributors to illness and pain, and are the leading contributor to disability worldwide.
The Unique Nature of Musculoskeletal Pain
Like all chronic pain, pain that stems from musculoskeletal conditions can vary greatly from person to person, and is dependent on the type of MSK conditions causing the discomfort.
Musculoskeletal pain usually includes:
- Muscle pain: A deep steady ache or random sharp pains. These can be isolated to one specific place, or all over.
- Bone pain: Dull, ongoing and aching pain that radiates from deep within the body. Bone pain like fractures can be sharper and more intense.
- Joint pain: Either constant or sporadic, joint pain can be throbbing, burning, or have a ‘grating’ sensation. Joints can also be sore, stiff or ache.
- Tendon and ligament pain: Sharp pains that often feel worse when the impacted area is moved.
Musculoskeletal pain can fluctuate based on activity levels, stress, sleep, and even a person’s emotional wellbeing. Where an acute musculoskeletal injury has occurred, pain serves a highly important role to alert the body to tissue damage, and to promote rest and healing. When pain endures long term and becomes chronic, as is common in up to 45% of sufferers with musculoskeletal pain, the role of pain can change dramatically.
Musculoskeletal Conditions and Nociplastic Pain
In chronic musculoskeletal conditions, pain may persist even after tissues have healed, or when medical diagnostics show little ongoing structural damage. This can be incredibly frustrating for patients, particularly if pain is moderate or severe. Chronic pain is not always driven by ongoing tissue injury, and when it comes to chronic pain, changes in the nervous system often play a significant role. When this occurs, the type of pain experienced by patients is referred to as nociplastic pain.
Nociplastic pain is a new type of pain classification that has evolved to describe the pain experienced by patients where there is no identifiable clinical cause. In nociplastic pain, the nervous system becomes more sensitive, amplifying pain signals and sometimes generating pain even in the absence of ongoing tissue harm.
Nociplastic pain is a common aspect of chronic musculoskeletal conditions and is often reported by patients who have chronic low back pain, fibromyalgia, ongoing knee and shoulder pain, and osteoarthritis.
It is vital for patients who are currently experiencing nociplastic pain to understand that a lack of physical findings does not mean the pain is psychological or simply imagined. The pain is just as real as neuroplastic or nociceptive pain, but instead of being driven by damage, it is driven by changes in how the brain and spinal cord process pain signals. Stress, trauma, mental health conditions, lack of sleep, and other experiences with pain can make pain signals more persistent, and harder to ‘switch off’.
The Importance of Multi-Strategy Treatment
Chronic musculoskeletal pain can be complex, and often stems from a combination of factors involving the nervous system and multiple, interrelated physical and psychological aspects of pain. As a result of this complexity, singular treatment pathways that are solely focussed on targeting just one of these factors often leave some symptoms unmanaged.
This is why multidisciplinary or multimodal medical care is generally considered best practice when it comes to treating and managing chronic pain. Major health organisations who work to support people suffering with chronic pain, including chronic musculoskeletal pain, such as the Department of Veterans Affairs, Pain Australia, and International Association For The Study of Pain have encouraged multidisciplinary care in the treatment of chronic pain. Multi-modal health is also outlined as a key aspect in better treatment approaches in the Australian Government’s National Strategic Action Plan For Pain Management.
Biopsychosocial Pain Management
Multidisciplinary care, also known as biopsychosocial management, is a care plan that treats the whole patient, not just a single symptom. A biopsychosocial approach considers physical health, nervous system sensitisation, psychological wellbeing, and lifestyle factors, and usually includes a care plan that involves more than one clinician. It can involve a GP, Pain Specialist, Psychologists, Allied Health specialists such as physios, dieticians, and sleep specialists. The goal is not only pain reduction, but also improved function, confidence in movement, and quality of life.
Pain Education: Pain education helps people recognise that pain does not always equal harm, reducing fear and avoidance of movement. This can improve engagement in treatment and support recovery.
Physical Therapy and Movement: Exercise therapies tailored to an individual’s needs and abilities is central to managing musculoskeletal pain. Physiotherapy and exercise physiology focus on restoring movement, strength, and flexibility while retraining the nervous system to feel safe with activity. Gentle, consistent movement can reduce pain sensitivity over time.
Psychology: Psychological therapies, particularly cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and pain-focused counselling, can help address the emotional and cognitive aspects of chronic pain. These approaches do not suggest pain is “all in the mind,” but rather acknowledge the strong connection between the brain and pain processing.
Pharmaceutical: Medications may be used to support pain management, particularly during flare-ups. In nociplastic pain, certain medications that act on the nervous system may be more helpful than traditional anti-inflammatory drugs. Medication choices should always be individualised and regularly reviewed.
Lifestyle and Self-Management Strategies: Sleep optimisation, stress management, pacing activities, mindfulness, and relaxation techniques play a key role in calming the nervous system. Poor sleep and chronic stress are known to increase pain sensitivity, so addressing these factors can significantly improve outcomes.
Multidisciplinary Pain Management: For people with complex or severe chronic musculoskeletal pain, multidisciplinary pain programs bring together GPs, allied health professionals, pain specialists, and psychologists. This coordinated approach provides comprehensive support and focuses on long-term self-management rather than short-term fixes.
Moving Forward with Musculoskeletal Pain
Chronic musculoskeletal pain is complex, but it is also manageable. Recognising the role of nociplastic pain helps explain why pain can persist and highlights the importance of treating the whole person, not just the affected body part.
With the right combination of education, movement, psychological support, and medical care, many people can reduce pain, improve function, and regain confidence in their bodies.
