Acute pain within the various components of the musculoskeletal system is a cardinal symptom of the pathophysiological processes involved with tissue damage, disease, or dysfunction. These disorders are generally well-characterised and management usually associated with good symptomatic and functional outcomes. Immediate activation of an inbuilt and hard-wired basic pain system serves a primary protective function to the host. Another system, perhaps best described as an advanced pain system, augments, amplifies, and extends the role of the pain system to other functions. Emotional distress has a potent effect on this process and drives a series of events that results in altered ‘downstream’ musculoskeletal symptoms and function. Under these circumstances chronic pain states may arise and may particularly involve the musculoskeletal tissues.
Fibromyalgia syndrome is used here as an example of a common chronic musculoskeletal pain syndrome, characterised by widespread pain and tenderness, in order to allow for discussion of the biopsychosocial inputs that must be addressed to provide the best clinical outcome. Emphasis is placed on understanding the nature of these problems, particularly to enhance reversibility and hence improve outcomes.
