Musculoskeletal pain: Causes, diagnosis, and treatment

By: Dr. Victor Marchione | Pain Management | Monday, September 04, 2017 - 05:00 AM

musculoskeletal painMusculoskeletal pain is the sensation of discomfort or pain of structures in the body affecting bones, muscles, ligaments, tendons, and nerves. Pain symptoms range from being mild to severe and can be acute or chronic in nature. Musculoskeletal pain can be local, affecting only a small area of the body, or be diffuse, with pain symptoms affecting a widespread area.

Lower back pain is the most common type of musculoskeletal pain, but the causes of the condition can be quite varied. Wear and tear, trauma, or even prolonged immobilization can cause musculoskeletal pain.

Various causes and symptoms of musculoskeletal pain

Musculoskeletal pain can be caused by any number of factors that affect the body. These include any of the following:

Bone pain

Possible due to osteomyelitis (bone infection), endocrine disorders, or tumors, it is often characterized by a deep, penetrating, or dull pain. The most common cause of pain occurs from injury.

Muscle pain (myalgia)

Can occur due to spasms or cramps from sustained muscle contraction. This is a common phenomenon experienced when sustaining a “charley horse” or a sustained painful muscle contraction of the calf. Muscle pain can be due to injury, loss of blood flow to the muscle group, infection, or a tumor.

Tendon and ligament pain

Common causes include tendinitis, tenosynovitis, lateral or medial epicondylitis, and tendon injuries. The most common cause of tendon and ligament pain occurs after acute injuries, such as from a sporting accident causing a sprain. Pain is often described as being sharp, becoming exacerbated when the affected tendon is stretched or moved. Rest is often enough to relieve tendon and ligament pain.


A small fluid-filled sac whose purpose is to provide protective cushioning around joints. Bursa pain can be caused by trauma, overuse, gout, or infection. Pain is typically worse when moving the affected joint and relieved by rest.

Joint pain (arthralgia)

Can be due to a multitude of different causes that may or may not be the result of inflammatory reasons, as is the case of arthritis. Inflammatory arthritis, as seen in cases of rheumatoid arthritis, osteoarthritis, and infections arthritis, not only cause musculoskeletal pain but can also affect the part of the bone inside the joint, leading to additional compilations. Pain is worse when the affected joint is moved, with some cases of joint pain originating in structures near the joint such as ligaments, tendons, and bursae.


A disorder characterized by widespread musculoskeletal pain, as well as by fatigue, problems sleeping, and memory and mood issues. Pain in this condition may be caused by pain in the muscles, tendons, or ligaments. Symptoms are often described as having tenderness in multiple locations that may be difficult for those affected to describe, but they are usually not related to any particular joint.

Nerve compression

Such conditions include carpal tunnel syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome. Pain often radiates along a path supplied by the nerve and may be described as feeling like burning, tingling, and/or numbness.

Related: Carpal tunnel syndrome may be triggered by smartphones

Referred pain (pain that travels)

Certain disorders of various internal organs may be perceived as musculoskeletal pain elsewhere in the body. For example, a disorder of the spleen or gallbladder may cause shoulder pain, a heart attack may cause arm pain, or a kidney stone may be felt as back pain.

Musculoskeletal pain diagnosis

Once a doctor is presented with possible musculoskeletal pain, the first thing acquired is a detailed history of your symptoms. This will also include all relevant medical history to help get a better idea of the pain origins. Next, a physical exam will be carried out to see if the area is sensitive to touch and how widespread the symptoms are. Depending on the severity of your particular injury, your doctor may or may not want to order additional testing. These tests include:

Blood testing

Certain conditions, such as rheumatoid arthritis, can present evidence of the condition as biomarkers in the blood. This can help with diagnosis and treatment. However, blood tests will not always provide any useful information in the majority of musculoskeletal pain and only recommended if there is the suspicion of an underlying condition.


Used to obtain an image of the bone to rule out any signs of fracture or abnormality. This test is not sensitive enough to evaluate muscle or other kinds of tissue.

Computer tomography (CT)

This test is able to get more detail about a bone fracture or bone problem compared to an x-ray.

Magnetic resonance imaging (MRI)

A great test for obtaining more detail of soft tissues such as muscles, bursae, ligaments, and tendons. This test can also be used for identifying bone fractures, but it’s not as quick or convenient as simply getting an x-ray.

Joint fluid testing

Done by inserting a needle in the joint and extracting the joint fluid. This can be useful for cases of septic or infectious arthritis where a bacterial infection has infected the joint, causing pain and complication. It can also be used to diagnose gout. Joint fluid testing may also be called arthrocentesis.

How to treat musculoskeletal pain?

Natural treatments

Rest: Constant stress on your muscles will make it difficult for the recovery process. Not taking the time to rest will often worsen musculoskeletal pain.

Ice: This may be done by simply applying ice on the affected knee to help reduce pain and swelling. Using an ice pack is ideal, but ice cubes in a towel or a bag of frozen vegetables will also do the trick. It is recommended to ice the affected part of the body for about 15 to 20 minutes every two to four hours.

Compression: Wrapping the area with medical gaze can help relieve pain and promote recovery
Elevate the joint: This can help relieve pressure on your knee joint and return blood to the upper part of the body. The general rule of thumb is to raise the knee higher than the level of the heart and supporting the leg with the use of pillows.

Strengthening exercises: This will prepare your body to better handle muscle aches and soreness. Stretching will also keep your muscles long and limber.

Acupuncture: An alternative form of medicine involving inserting thin needles into key points on the body and most often used for pain relief. Considered traditional Chinese medicine, acupuncture is thought to be a technique for balancing the flow of energy or life force known as qi or chi (pronounced CHEE). This force is believed to flow through various pathways of the body.

Other treatments

Topical analgesics: These remedies work by halting the chemical transmission of pain from the affected area to the brain. Topical analgesics can come in creams, ointments, gels, or lotions and are applied directly to the skin in the area of musculoskeletal pain.

Non-steroidal anti-inflammatory drugs (NSAIDs): A common pain-relieving medication that can be commonly found in many pharmacies and grocery stores. They are designed to reduce pain and swelling. However, long term use of these drugs may lead to liver damage and increase the risk of heart attacks. NSAIDs can also be found in topical solutions and don’t pose as much risk as oral formats. However, this form of medical treatment is preferred over opioid use for musculoskeletal pain sufferers.

Chiropractic care: A division of medicine that caters almost exclusively to the treatment of musculoskeletal pain. Chiropractors use techniques such as osteopathic manipulation as well as hands on spinal realignments.

Acupressure techniques: Achieved through gentle massage of the affected area helping to reduce pain and soreness. You can also incorporate coconut oil to help with the massage process as it is an effective herbal remedy.

Corticosteroid injections: A highly effective therapy for reducing inflammation and pain, with some cases of chronic pain being relieved for up to a year. Pain may also diminish with subsequent injections.

Related: Elderly with chronic musculoskeletal pain (CMP) face greater heart disease risk

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