Musculoskeletal Pain: Symptoms, Causes and Treatment

Musculoskeletal pain is one of the most common health complaints worldwide, affecting people of all ages and backgrounds. Whether it’s a fleeting ache after physical exertion or persistent discomfort that disrupts daily life, understanding musculoskeletal pain is essential for effective prevention and management. This article explores the symptoms, causes, and evidence-based treatments of musculoskeletal pain, empowering you with knowledge to navigate this widespread health issue.

Symptoms of Musculoskeletal Pain

Musculoskeletal pain can present in many ways, ranging from mild and fleeting to severe and long-lasting. Recognizing the signs early can help with timely intervention and improved outcomes.

Symptom	Location/Type	Prevalence/Severity	Source
Fatigue	Generalized	Common, especially post-viral	1
Joint pain	Localized/Widespread	4.6%–18.6%, sometimes severe	1 2
Myalgia	Muscle aches	5.65%–15.1%, often widespread	1 2
Back pain	Low back, spine	Highly prevalent, recurrent	3 4
Neck pain	Neck, shoulders	Frequent, affects routine	4
Headache	Head, sometimes tension-related	Very common, especially in youth	4
Severity	Varies (mild to severe)	Often mild but can be disabling	4 9

Table 1: Key Symptoms

Types of Musculoskeletal Pain

Musculoskeletal pain can manifest as localized discomfort—such as in a specific joint or muscle—or as widespread pain affecting multiple areas. Commonly reported types include:

• Fatigue: Not just tiredness, but a deep sense of physical exhaustion often linked with chronic or post-viral conditions, including post-COVID syndromes 1.
• Joint Pain (Arthralgia): Ranges from mild aches to disabling pain in one or more joints. It can be episodic or persistent, sometimes affecting multiple joints simultaneously 1 2.
• Muscle Pain (Myalgia): Often described as aching, throbbing, or tenderness in the muscles. Myalgia can be acute, following exertion or injury, or chronic as seen in conditions like fibromyalgia 1 2.
• Back and Neck Pain: These are among the most frequent reasons for seeking medical advice. Low back and neck pain are particularly common in both adults and adolescents, often linked to daily activities or posture 3 4.
• Headaches: While not always considered classic musculoskeletal pain, tension-type headaches often arise from muscular tension in the neck and shoulders 4.

Prevalence and Patterns

Musculoskeletal pain is extremely common:

• Adolescents: Up to 76% reported symptoms within a single week, with headaches, neck, and shoulder pain being particularly prevalent. Prevalence increases with age and is significantly higher in females 4.
• Adults: Most people experience musculoskeletal pain at some point, especially with advancing age. Chronic pain becomes more common with age and can be highly intrusive 9.
• Post-Infection: After illnesses like COVID-19, up to 43% of people may still have musculoskeletal symptoms six months later 1 2.

Severity and Impact

The severity of musculoskeletal pain varies:

• Often rated around 4 out of 10 in terms of intensity among adolescents, but can be higher in chronic or widespread cases 4.
• Can interfere with routine activities like school, work, or exercise 4 9.
• Chronic pain, especially when widespread, is more likely to be associated with psychological distress and disability 5 9.

Causes of Musculoskeletal Pain

Understanding what triggers or perpetuates musculoskeletal pain is key to both prevention and management. Causes can be simple or complex, and are often multifactorial.

Cause	Description	Notable Risk/Association	Source
Overuse/Repetitive Strain	Repetitive or unusual activity	School bags, computer use, sports	4 9
Acute Injury	Trauma, accidents	Common in all age groups	9
Disease/Pathology	Arthritis, infections	Chronic or secondary pain	8 9
Lifestyle Factors	Inactivity, poor diet, smoking	Higher pain risk in sedentary/smokers	7
Psychological Factors	Stress, anxiety, catastrophizing	Pain and stress are mutually reinforcing	5 6 14
Post-infectious	After viral infections	Long COVID, persistent pain	1 2

Table 2: Main Causes

Mechanical and Lifestyle Causes

• Overuse and Repetitive Strain: Activities that put repeated or excessive load on muscles and joints—like carrying heavy backpacks, prolonged computer use, and intense sports—are common triggers, especially in adolescents and workers 4 9.
• Acute Injury: Falls, accidents, and sports injuries can cause sprains, strains, fractures, or dislocations, leading to acute or sometimes chronic musculoskeletal pain 9.
• Lifestyle Factors:
  • Physical inactivity increases risk, while regular activity reduces it 7.
  • Poor nutrition and smoking are associated with higher pain intensity 7.

Disease-Related Causes

• Musculoskeletal Disorders: Arthritis (including osteoarthritis and rheumatoid arthritis), osteoporosis, and other joint/bone diseases are significant sources of chronic pain 8 9.
• Systemic Illnesses: Some infections, such as COVID-19, can lead to prolonged musculoskeletal symptoms long after the initial illness has resolved 1 2.

Psychosocial and Biopsychosocial Factors

• Psychological Stress: There is a two-way relationship between musculoskeletal pain and stress. Pain can make people more sensitive to stress, and stress can amplify the perception of pain 6.
• Central and Peripheral Sensitization: Persistent pain can lead to changes in the nervous system, making the body more sensitive to pain signals—a process called sensitization 5.
• Biopsychosocial Model: Chronic musculoskeletal pain often involves an interplay of biological, psychological, and social factors. Factors like pain catastrophizing, anxiety, and fear of movement can perpetuate pain even after the physical injury has healed 5 8 14.

Post-Infectious Causes

• Long COVID and Other Viruses: Persistent joint pain, myalgia, and fatigue are common long after recovery from infections like COVID-19 1 2. These symptoms can be widespread and affect quality of life.

Treatment of Musculoskeletal Pain

Effective management of musculoskeletal pain requires a tailored, evidence-based approach that addresses not just the physical symptoms but also the underlying causes and contributing factors.

Treatment	Approach/Modality	Effectiveness/Role	Source
Exercise Therapy	Aerobic, resistance, individualized	Strong evidence for pain relief and function	11 14
Psychosocial Interventions	CBT, education, biopsychosocial	Effective, especially for chronic/widespread pain	10 11 14
Pharmacologic	NSAIDs, opioids, muscle relaxants	Short-term relief, modest effect, risk of side effects	11 12
Injections	Steroids, hyaluronic acid	Short-term benefit for some conditions	12
Complementary Approaches	Natural products, mind-body therapies	Widely used, variable evidence of benefit	13
Lifestyle Modifications	Physical activity, diet, smoking cessation	Preventive, reduces pain risk	7 10

Table 3: Treatment Approaches

Non-Pharmacological Treatments

• Exercise Therapy:
  • Recognized as one of the most effective treatments for musculoskeletal pain, especially chronic cases.
  • Includes aerobic, resistance, and flexibility exercises tailored to the individual's preferences and abilities.
  • Exercise should be supervised, individualized, and perceived as safe to prevent fear or avoidance behaviors 11 14.
• Psychosocial Interventions:
  • Cognitive-behavioral therapy (CBT), pain education, and addressing psychological factors are crucial, particularly in chronic or widespread pain.
  • The biopsychosocial approach—addressing physical, psychological, and social contributors—has the best evidence for improving outcomes 10 14.
• Lifestyle Changes:
  • Increasing physical activity, improving diet (increasing fruits and vegetables), and quitting smoking can reduce pain severity and risk of chronic pain 7 10.
  • Maintaining engagement in work or daily activities is encouraged; prolonged rest is discouraged 10.

Pharmacological Treatments

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Opioids:
  • Offer short-term pain relief, but the benefits are modest.
  • Opioids in particular should be used cautiously due to risks of dependence and side effects 11 12.
• Muscle Relaxants:
  • May help in some cases, particularly with acute low back pain 12.
• Steroid Injections and New Agents:
  • Steroid injections may provide brief relief for knee or shoulder pain, but benefits are limited and short-lived 12.
  • Newer agents (hyaluronic acid, avocado-soybean unsaponifiables, etc.) show promise but require more research 12.

Complementary and Alternative Therapies

• Natural Products and Practitioner-Based Approaches:
  • Widely used by those with musculoskeletal pain, including supplements and therapies like acupuncture or chiropractic care.
  • Evidence of effectiveness varies, and these approaches should be discussed with healthcare providers 13.
• Mind-Body Approaches:
  • Relaxation techniques, meditation, and similar practices may help some individuals manage pain and associated stress 13.

Best Practice Recommendations

High-quality clinical guidelines consistently recommend:

• Patient-centered care and shared decision-making
• Screening for serious conditions ("red flags")
• Selective use of imaging
• Regular monitoring of progress
• Education and self-management support
• Physical activity and exercise as cornerstones of management
• Manual therapy only as an adjunct
• Prioritizing non-surgical care before surgical options 10

Conclusion

Musculoskeletal pain is a complex, widespread health issue that can significantly impact quality of life. Understanding its symptoms, causes, and treatments allows for more effective management and prevention. Key points include:

• Symptoms: Range from fatigue and joint pain to back, neck, and headache; can be mild or severe, acute or chronic.
• Causes: Include overuse, injury, disease, lifestyle factors, psychological influences, and post-viral syndromes like long COVID.
• Treatment: Most effective approaches are exercise therapy and psychosocial interventions, supported by lifestyle changes. Medications and injections may help some, but benefits are often limited and short-term. Complementary therapies are popular but require careful consideration.

Summary of Main Points:

• Musculoskeletal pain is extremely common and varies widely in severity and cause.
• Risk factors include repetitive use, injury, poor lifestyle habits, and psychological stress.
• Chronic pain often involves both physical and psychological contributors.
• Best evidence supports exercise, psychosocial interventions, and lifestyle changes.
• Pharmacological treatments offer only modest, short-term benefits.
• Patient-centered, biopsychosocial care is the gold standard for chronic pain management.

By understanding and addressing both the physical and psychological aspects of musculoskeletal pain, individuals and healthcare providers can work together for better outcomes and improved quality of life.