Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal clinicians. (February 2021)

• Record Type: Journal Article
• Authors: Beales, Darren; Mitchell, Tim; Moloney, Niamh; Rabey, Martin; Ng, Wendy; Rebbeck, Trudy
• Is Part Of: Musculoskeletal science and practice. Volume 51(2021)
• Publication Date: 2021-02
• Subjects: Musculoskeletal -- Pain -- Sensitivity -- Clinical practice; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy Modalities; Electronic journals; Periodicals; 615.82
• DOI: 10.1016/j.msksp.2020.102221
• Languages: English
• ISSNs: 2468-8630

Abstract

Abstract: Introduction: Research on musculoskeletal disorders indicates that pain sensitivity can be an important consideration for musculoskeletal clinicians in the holistic view of a patient presentation. However, diversity in research findings in this field can make this a difficult concept for clinicians to navigate. Limited integration of the concept of pain sensitivity into clinical practice for musculoskeletal clinicians has been noted. Purpose: The purpose of this masterclass is to provide a framework for the consideration of pain sensitivity as a contributing factor in the presentation of people with musculoskeletal pain. It provides pragmatic synthesis of the literature related to pain sensitivity through a lens of how this information can inform clinical practice for musculoskeletal clinicians. Guidance is provided in a 'how to' format for integration of this knowledge into the clinical encounter to facilitate personalised care. Implications: The relationship of pain sensitivity with pain and disability is not clear or linear. The real importance of pain sensitivity in a clinical presentation may be: (1) the potential for pain sensitivity to modify the effect of common treatments utilised by musculoskeletal clinicians, or (2) the effect of pain sensitivity on the prognosis/course of a disorder. Screening tools and subjective features have been highlighted to indicate when physical assessment of pain sensitivity should be prioritised in the physical examination. A pragmatic blueprint for specific assessment related to pain sensitivity has been outlined. A framework for integrating assessment findings into clinical reasoning to formulate management plans for the pain sensitive patient is provided. Highlights: Pain sensitivity encompass the phenomena of an enhanced pain experience. Pain sensitivity may modify the effect of common musculoskeletal pain treatments. The patient interview can allude to pain sensitivity as a significant factor. Specific clinical tests can provide an objective measure of pain sensitivity. A framework to consider management of pain sensitivity is provided.