Treatment of inflammatory pain at primary care

Pain related to the musculoskeletal system is the most frequent type of chronic pain. It can be caused by overwork and frequent microinjuries of soft tissue, osteoarthrosis, connective tissue diseases, inflammation, osteoporosis, fibromyalgia, neoplastic diseases, or injuries. Of these, osteoarthrosis and diseases of the spine (its lower portion) are the most common. Major risk factors of musculoskeletal pain are: age, sex (female), genetic predisposition, and depressive disorders. Musculoskeletal pain is nociceptive and inflammatory in nature; hence, the introduction of nonsteroidal anti-inflammatory drugs (NSAIDS) is required for periods of exacerbation. In 30–40% of patients with musculoskeletal pain some features of neuropathic pain can be identified because inflammatory process may cause this type of pain even without nerve damage. Successful therapy depends on proper pain assessment (pathomechanism, severity, character, location) and unique therapy for every patient. Pharmacological treatment should be based on the WHO analgesic ladder in all cases.