Preface

Article Outline

• Copyright

Musculoskeletal pain is one of the most frequent reasons for seeking medical help and advice, for disability and absence from work. The complaints may be associated with a variety of biopsychosocial and cultural conditions, and may clinically appear as a localized or regional problem, or widespread musculoskeletal pain.

This issue focuses on regional musculoskeletal pain. Patients with regional musculoskeletal pain are most frequently seen by general practitioners, but also by rheumatologists, orthopaedic surgeons and specialists in physical medicine and rehabilitation, including sports medicine. Thus, this issue should potentially be of interest for physicians from a variety of specialities, and also for physiotherapists and other health professionals involved in the multidisciplinary managements of patients with regional musculoskeletal pain.

When planning this issue we wanted partly to focus on specific regions of interest, but also to cover some general topics related to diagnosis and treatment. Knowing that identification of the origin of regional musculoskeletal pain is a real challenge for the practising doctor, this issue starts with a chapter focusing on clinical examination, including both the disease history and diagnostic tests. Over the last years there has been a growth and development in the availability of imaging modalities that can be used to identify the origin of regional musculoskeletal pain. Thus, one chapter reviews these advances and discusses how MRI, ultrasonography and other relevant imaging techniques can be applied to improve the diagnostic accuracy. The value of an imaging assessment is related to the quality of the referrals from the clinician. Proper clinical examination is described in each of the regional chapters and recent advances are addressed.

This issue especially focuses on regional musculoskeletal pain in five different regions—the shoulder, neck, hip, foot, forearm and hand. In general, each chapter on these regions deals with epidemiological aspects, potential causes of the regional pain, risk factors, differential diagnoses and principles of treatment. Our goal is that readers may be assisted in their daily clinical work as these chapters provide the recent evidence for how to diagnose and manage regional musculoskeletal pain within these five different regions.

The final three chapters of this issue deal with therapeutic aspects. All chapters aim to provide the best evidence available within three important areas: pharmacotherapy, local injection therapy and rehabilitation. These chapters also highlight evidence knowledge from controlled clinical trials, but in general the knowledge for regional muscular skeletal pain is weaker than for many other medical conditions. This fact may be related to weakly defined diagnostic and classification criteria of regional musculoskeletal pain as well as lack of consensus on efficacy end-points. However, we still think these chapters provide the most up-dated review of drug, injection therapy and rehabilitation of musculoskeletal pain, including references to relevant Cochrane reviews.

This collection of 10 chapters is rather comprehensive, but its content must be considered in the context of previous issues of this journal. Our goal was to make an issue that should have limited overlap with previous issues and at the same time, when relevant, provide updated evidence-based reviews on topics that have been presented before. Thus, the reader may find complementary information of relevance also in previous issues, and we will especially mention another issue on regional musculoskeletal pain from 1999 (volume 13, number 2) in this series that covered aspects of diagnostics and management, which are not focused on in this issue.