Behind the Book

Musculoskeletal pain — including fibromyalgia, work-related myalgia, myofascial pain, strain injuries, low back pain, and arthritis and other inflammatory conditions of the muscles, tendons, and joints — is a major medical and economic problem. We asked lead editor Dr. Thomas Graven-Nielsen to describe why the book is such a unique resource.
 
Q: Why is there a need for a book on this topic?
A: The last few years have seen an extensive number of original, peer-reviewed publications in this field, so the time is right for an updated comprehensive overview of the mechanisms of musculoskeletal pain. Perhaps this book’s most useful and timely contribution is to highlight the translation of findings from basic animal studies, and from human experimental pain studies, into potential clinical mechanisms.
 
Q: What do you consider some of the most exciting areas of research on musculoskeletal pain?
A: The scientific approach in which basic animal findings are translated into human manifestations is yielding exciting, new insights into the mechanisms involved in chronic musculoskeletal pain in patients. This type of new knowledge is fundamental for developing improved treatments.
 
Q: Is the book relevant for clinicians treating musculoskeletal pain?
A: Definitely. Clinicians will find this book a useful resource to update them on current knowledge about the mechanisms involved in musculoskeletal pain. Over the past decade, our understanding of these mechanisms has changed dramatically. Previous beliefs were adopted from pain research that did not specifically target deep-tissue pain. Today we know about additional mechanisms that are only relevant to musculoskeletal pain. This book gives the full picture, including the functional effects of pain (movement disturbances due to muscle pain) as well as sensory manifestations (such as referred pain and hyperalgesia). Several chapters highlight current clinical views on musculoskeletal pain, including fibromyalgia, clinical aspects of muscle and joint pain, work-related pain, neck pain, temporomandibular pain, and low back pain.
 
Q: Does the book offer any new insights on why musculoskeletal pain conditions are more prevalent in women?
A: The book presents new views on gender differences in musculoskeletal pain conditions. It describes evidence for sex-related differences in muscle afferent responses and estrogen-related modulation of receptor expression and function. It is still an open issue whether sex-related differences in muscle afferent discharge contribute to differences in the incidence and prevalence of chronic myofascial pain.
 
Q: Please tell us about the symposium on which this book was largely based.
A: Many of the book chapters are based on presentations at the 7th IASP Research Symposium, “Fundamentals of Musculoskeletal Pain,” which took place in May 2007 at Aalborg University’s Center for Sensory-Motor Interaction [in Denmark]. We were extremely pleased to see the genuine interest among the 180 participants from around the world and to hear their lively discussions of the topic during the meeting.
 
Q: The last section of the book focuses on the effects of pain on motor function. What are some of the most important clinical aspects of new insights in this area?
A: Researchers had believed that deep-tissue pain facilitates muscle activity, which was thought to cause more pain, leading to a vicious cycle. The main new insight on this topic is that pain has a more adaptive role, so that musculoskeletal pain decreases muscle activity and range of motion, which will eventually overload other muscles and structures.
 
Q: Do you have any words of encouragement on potential novel therapies for clinical pain?
A: Many contributions to this book highlight the importance of facilitation in central neural mechanisms of musculoskeletal nociception, such as the widespread allodynia that occurs in animal models of muscle nociception and enlarged areas of referred pain in patients with chronic musculoskeletal pain. These new insights on plasticity might guide the development of novel targeted treatment regimes. The book explains that some of the pain manifestations in chronic musculoskeletal pain conditions are consequences of sensitization. Some of the management strategies used to manage neuropathic pain also apply to chronic musculoskeletal pain conditions. This concept is slowly being clinically accepted, and the drugs used in neuropathic pain are being used in conjunction with traditional musculoskeletal pain management regimes.