Individual and population differences affect the pain management in acute musculoskeletal injury

Abstract

In this editorial, we comment on the article published in a recent issue of the World Journal of Orthopedics. Although substantial literature regarding pain management of acute musculoskeletal injury has been published over the last three decades, there is still a lack of evidence-based protocol for individual and population disparities. This systematic review gives us a comprehensive view of the evidence-based use of opioid vs opioid-free analgesia. Nevertheless, there is still a need for further investigation at a high level regarding this topic.

Key Words: Acute musculoskeletal injury; Acute traumatic pain; Non-opioid analgesia; Non-opioid pain control; Opioid-sparing analgesia; Opioid crisis

Core Tip: For patients sustaining pain from acute musculoskeletal injury, non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury. We need to be aware that pain intensity may vary widely from different injury patterns, age groups, and other baseline characteristics. Individual and population differences affect the pain management in acute musculoskeletal injury.

INTRODUCTION

For patients experiencing persistent pain due to acute musculoskeletal injury, pain management in the emergency department remains a challenge for clinical practitioners to implement[1]. On the one hand, effective pain relief may contribute to a decrease in pain-related psychological and emotional disturbances; furthermore, effective pain management can enhance the patient-physician relationship. On the other hand, opioid use disorders and epidemics have led to public health crises[2].

Although a considerable number of studies on pain management for acute musculoskeletal injury have been published over the past three decades, there is still a lack of evidence-based protocols for individual-level and population-level differences. To address this issue, a comprehensive approach is needed. This includes not only the use of appropriate analgesics but also non-pharmacological methods such as physical therapy, psychological counseling, and alternative medicine. Moreover, individualized pain management plans should be developed based on the patient's specific condition, medical history, and personal preferences[3]. Close monitoring and evaluation of the treatment's effectiveness are essential to ensure optimal pain relief and minimize the risk of adverse effects.

EVIDENCE-BASED PAIN MANAGEMENT IN ACUTE MUSCULOSKELETAL INJURY

In the review article by Fiore et al[4], which was published in the recent issue of the World Journal of Orthopedics, 12 randomized clinical trials (RCTs) and 2 pseudo-RCTs with a total of 2347 patients were examined. The findings revealed that non-opioid analgesics can be considered effective alternatives during the initial treatment phase among patients with acute musculoskeletal trauma. This systematic review provided a comprehensive view of the evidence-based use of opioid versus opioid-free analgesia. Nevertheless, it is important to note that pain intensity may vary widely across different injury patterns, age groups, and other baseline characteristics. There is an absence of subgroup and interaction analyses across these trials. More details about front-line patient-specific regimens for acute musculoskeletal injury in the emergency room are needed[5]. Furthermore, there is a need for further investigation at a high level regarding this topic. Additionally, further research is required to better understand the underlying mechanisms of pain in acute musculoskeletal injury and to identify novel therapeutic targets. This may involve the exploration of biomarkers, genetic factors, and neural pathways associated with pain perception and modulation[6]. In conclusion, effective pain management in the emergency department for patients with acute musculoskeletal injury requires a multimodal approach that takes into account individual and population disparities, as well as the need for evidence-based protocols and ongoing research.

CONCLUSION

For patients sustaining pain from acute musculoskeletal injury, non-opioid analgesics can be considered effective alternatives during the initial treatment phase. Pain intensity may vary widely across different injury patterns, age groups, and other baseline characteristics. Individual- and population-level differences affect pain management in acute musculoskeletal injury patients.