Pharmacologic pain treatment of musculoskeletal disorders: Current perspectives and future prospects

Objective: The authors aimed to provide an educational update on the curren t evidence of the effectiveness of drug therapy in the treatment of musculo skeletal pain and to offer a perspective of possible future developments. Design: The authors used a pragmatic review of data provided by available s ystematic reviews and seminal controlled studies pertaining to the treatmen t of regional musculoskeletal pain problems. Results: Epidural steroids may offer limited, short-term benefit for sciati ca. Local injections of steroids are either ineffective or provide short-la sting benefits. Nonsteroidal anti-inflammatory drugs and opioids reduce pai n, but the effect size is modest. The literature does not support convincin gly the use of antidepressants. Certain muscle relaxants may be useful in t he treatment of back pain. Hyaluronic acid, neutraceutical agents, avocado- soybean unsaponifiable agents, oxaceprol and diacerein may be effective in the treatment of osteoarthritis, but the information regarding these new ag ents does not allow wholesale endorsement of these substances. Selective ep idural injection of steroids at a target nerve root approached through the intervertebral foramin has the potential to replace the traditional epidura l approach. Long-acting, C-fiber-specific local anesthetics are under inves tigation and could provide long-lasting pain relief without motor or sensor y impairment. In the future, central hypersensitivity in chronic musculoske letal pain might be treated using antagonists of the N-methyl-D-aspartate r eceptor. Cannabinoid agents produce antinociception and prevent experimenta lly induced hyperalgesia in animals, and they may find a role in pain manag ement. Methods to optimize drug combinations are available. Conclusions: The effectiveness of the currently available drugs in the trea tment of musculoskeletal pain conditions is disappointing. Recent developme nts may open new perspectives in this area of pain medicine.