Non-malignant diseases: health outcomes after musculoskeletal injury

Musculoskeletal pain following a road traffic crash is common and incurs substantial personal and economic costs. Current recommended treatments of reassurance and advice to stay active, exercise and simple analgesics are not very effective. This review describes the current evidence for health outcomes and potential processes involved in the persistence of pain. It also outlines promising current and future treatments aimed at the prevention of chronic pain after musculoskeletal injury.

Recent literature highlights a more complex clinical presentation including greater pain-related disability and nociplastic pain features of traumatic musculoskeletal pain compared to non-traumatic pain. Some studies have found evidence for the presence of neuropathic pain in a sub-group of patients. Accurate risk-prediction screening tools exist for neck pain following road traffic injury and clinical trials using these tools show promise where treatment is targeted to identified risk factors.

Traumatic musculoskeletal pain is characterised by a more complex, high-burden clinical presentation, with worse health outcomes compared to non-traumatic musculoskeletal pain. There is emerging evidence that multi-factorial stress-related processes, neuroimmune factors, and neuropathic pain may underlie these differences. Early treatments targeting risk factors for poor recovery, including stress symptoms and pro-nociceptive processes show promise in improving outcomes for injured people.