Neuro-immune contributors to persistent musculoskeletal pain: from mechanisms to clinical assessment and management

Abstract

Introduction: Persistent musculoskeletal (MSK) pain conditions are highly prevalent and economically burdensome. Although extensive research has explored various management strategies for these conditions, most interventions yield only modest effects. Recently, there has been increasing recognition of neuro-immune contributions in several persistent MSK pain conditions not traditionally associated with such influences.

Purpose: The aim of this Masterclass is to provide an overview of some key neuro-immune factors that may contribute to persistent MSK pain whilst detailing both simple bedside and advanced novel methods to identify such neuro-immune contributions. It will also examine why an understanding of such contributions may be beneficial for the assessment and management of people with persistent MSK pain conditions.

Implications: Understanding neuro-immune contributions to persistent MSK pain and how to identify them will help clinicians to i). consider the involvement of the nervous and immune systems when managing people with persistent MSK pain conditions, ii). better understand the use of both simple bedside tests and novel methods to identify such mechanisms and iii). consider how neuro-immune contributions may inform management strategies.

Keywords: MR neurography; Neuro-immune contributions in persistent MSK pain; Quantitative sensory testing; Systemic inflammation.