Feature Article

Acute and chronic musculoskeletal pain: pharmacological management

Stephan A Schug, Ahmad Afifi Mohd Arshad



A multimodal, multidisciplinary approach is required when managing patients with musculoskeletal pain. Nonopioid analgesics should be trialled first and opioids then used with caution.

Key Points

  • Musculoskeletal pain is common and has significant consequences for affected patients and society as a whole.
  • Musculoskeletal pain is not purely nociceptive; peripheral inflammation and central sensitisation processes, as well as neuropathic components, contribute.
  • Management of patients with these conditions should be multimodal and multidisciplinary, not rely on pharmacological approaches alone, and follow principles of chronic disease management aiming for improved function.
  • Nonopioid analgesics, in particular NSAIDs, play an important role in the pharmacological management of patients with these conditions.
  • Opioids should be used with caution and only after careful consideration in patients with musculoskeletal pain; tramadol, buprenorphine and tapentadol may be preferable here.
  • Adjuvants such as anticonvulsants (e.g. pregabalin) and antidepressants (e.g. duloxetine) may play a previously underestimated role in the management of patients with musculoskeletal pain.

    Picture credit: © McDermott Pain Management 2015. US Copyright Registration # VAu 001-20-4996