Primary Care Strategies for Managing Musculoskeletal Pain: A Narrative Overview

Musculoskeletal pain (MSP), including conditions such as osteoarthritis, low back pain, tendinopathies, and soft tissue disorders, is one of the most frequent reasons for primary care (PC) office visits and a leading cause of disability worldwide. MSP imposes a sizeable socioeconomic burden due to work absenteeism, healthcare utilization, and loss of productivity. Primary care practitioners (PCPs) are central to identifying and managing MSP, particularly in the early stages, where timely intervention can prevent chronicity and reduce disability. This narrative review presents clinical guidance and current evidence on the assessment and management of MSP in PC settings. Our study highlights the importance of a comprehensive, multidisciplinary approach that includes clinical evaluation with red and yellow flag screening and judicious use of imaging, followed by the selection of appropriate pharmacologic therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvants based on pain severity and comorbidities. Non-pharmacologic interventions, such as psychological support, manual therapy, exercise therapy, and patient education, are central to long-term management. The review further emphasizes the integration of digital health tools and care models, such as the Subgroups for Targeted Treatment (STarT) Back approach, in improving care coordination and accessibility. Despite well-established guidelines, gaps in practice remain, including poor access to physiotherapy, limited consultation time, and the overuse of diagnostic imaging and opioids. Filling these gaps requires better clinician education, enhanced access to allied health services, and system-level support for providing conservative, patient-centered care.