Pain Mechanisms and Therapeutic Assessments in Musculoskeletal Systems

Musculoskeletal pain encompasses a spectrum of nociceptive, neuropathic and nociplastic components arising from bones, joints, muscles and connective tissues. Peripheral sensitisation of nociceptors in response to inflammation or mechanical stress may trigger pain signals, while central sensitisation amplifies these signals through maladaptive spinal and supraspinal plasticity. Myofascial trigger points serve as focal loci of hyperirritability that can generate local and referred pain via altered autonomic activity. Accurate assessment of these mechanisms relies on a combination of clinical evaluation, quantitative sensory testing and advanced imaging or thermographic techniques. Emerging diagnostic protocols integrate real-time measures of skin temperature changes, pressure and thermal pain thresholds to distinguish between nociceptive, neuropathic and nociplastic contributions. Therapeutic approaches are increasingly tailored to the underlying phenotype, combining manual therapies, dry needling, pharmacological modulation of central pathways and neuromodulation to restore normal afferent processing and improve functional outcomes. The global burden of chronic musculoskeletal pain underscores the need for objective biomarkers and standardised assessment protocols to guide personalised interventions and monitor treatment efficacy.

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Pain Mechanisms and Therapeutic Assessments in Musculoskeletal Systems publication trend

The graph below shows the total number of articles in pain mechanisms and therapeutic assessments in musculoskeletal systems across all publications each year (not limited to Nature Index journals).

Technical terms

Nociplastic pain: Pain arising from altered nociception despite no clear evidence of tissue damage or lesion of the somatosensory system.

Central sensitisation: Increased responsiveness of central nociceptive neurons to normal or subthreshold afferent input, leading to pain amplification.

Myofascial trigger point: A hyperirritable spot within a taut band of skeletal muscle that is painful on compression and can produce referred pain.

Referred pain: Pain perceived at a location distant from the site of the actual noxious stimulus, due to convergence of sensory pathways.

Quantitative sensory testing (QST): A set of psychophysical methods to assess thermal, mechanical or pressure pain thresholds to characterise sensory dysfunction.

References

1. Referred pain: characteristics, possible mechanisms, and clinical management. Frontiers in Neurology (2023).
2. Amplified Vasodilatation within the Referred Pain Zone of Trigger Points Is Characteristic of Gluteal Syndrome—A Type of Nociplastic Pain Mimicking Sciatica. Journal of Clinical Medicine (2021).
3. Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. Revista da Associação Médica Brasileira (2022).
4. Relationship between pressure and thermal pain threshold, pain intensity, catastrophizing, disability, and skin temperature over myofascial trigger point in individuals with neck pain. Revista da Associação Médica Brasileira (2021).