According to the World Health Organization (WHO), more than 1.7 billion people suffer from musculoskeletal disorders (MSK).1.2 Musculoskeletal conditions are the leading causes of disability worldwide, with low back pain and osteoarthritis being the leading causes of physical disability worldwide, with a prevalence of 700 million and 500 million people, respectively.3.4 Aging, changing demographics and a steady increase in the world’s population mean that the number of people with musculoskeletal disorders is increasing rapidly and disability associated with musculoskeletal disorders is expected to continue to increase over the coming decades. This highlights the need to prioritize musculoskeletal disorders and increase the basic skills of medical practitioners to develop better tools to help and reassure their patients, with an increasing number of cases.5–8
Musculoskeletal conditions are typically characterized by pain, often chronic and persistent, with limitations in mobility, dexterity and general level of functioning, reducing quality of life and work capacity.1 Traditionally, the treatment of musculoskeletal pain and its clinical management have focused on the use of conventional pharmaceuticals to relieve symptoms. However, many of the analgesics currently available have significant side effects and adverse effects on the cardiovascular, renal, and gastrointestinal systems.9–12 The opioid epidemic has also highlighted the unmet medical need for pain management; highlighting opportunities for developing, testing and implementing multimodal pain management solutions.13–15
A recent review article by McSwan, Gudin and their co-authors introduced the concept of “self-healing” to musculoskeletal pain management.16 In this article, the authors discuss the role of multidisciplinary, multimodal and integrative approaches in the management of musculoskeletal pain.16 They highlight the increased use of alternative and complementary treatments by patients and the need to incorporate natural remedies into clinical management and treatment guidelines. In addition to highlighting the role of alternative and complementary treatments, they offer the new and plausible concept that the human body has an innate ability to “heal itself” and that this ability can be optimized through the use of medical strategies. integrative (Figure 1). The factors that trigger acute or recurrent musculoskeletal pain are diverse and can range from physical stress to psychological stress, which applies to many age groups, including adolescents.17 The mechanisms used by the body to respond to these pain triggers and “self-heal” are thought to work through five bodily networks. The nervous system can promote the restoration and healing of the body through the relaxation response. Psychology and the reduction of mental stress can help reduce muscle activity and therefore pain. Modulation of the immune system by acute inflammation may play a critical role in muscle regeneration. An increase in microcirculation can promote healing and reduce pain. Muscle relaxation/contraction increases the supply of oxygen and nutrients and relaxes the muscle. These restorative processes can be enhanced through the application of multimodal and integrative approaches, thereby promoting the idea of “self-healing” despite unfamiliar processes and complexities.18.19
Figure 1 Self-healing and multimodal integrative medicine.
“Self Healing” is a new way of thinking for musculoskeletal pain management and reinforces the potential for integrating multimodal medicine through new research and the implementation of multimodal approaches through a open dialogue between patients and healthcare providers.20 The effectiveness of pain management solutions should be specific depending on the diagnosis, but may encompass lifestyle modification including nutrition, assessment of food intake, posture, physical activity and exercise,21 cognitive-behavioral therapy and body/mind techniques,22 many of which are beginning to appear in treatment guidelines.
Unfortunately, the pandemic has set us back in all previously established initiatives to improve musculoskeletal health, highlighting the need for pragmatic approaches to pain management in the post-COVID-19 era.23 Describing key priorities for establishing the concept of “self-healing” in a primary health care setting is clearly beyond the scope of this editorial and the efforts of a single author. Further work by academia, industry, health authorities and regulatory bodies is needed to establish the concept of “self-healing” as a priority area in pain management.
In summary, “self-healing” aims to harness the innate ability of the body and mind to promote mechanisms to restore physiological set points and restore balance to the MSK system, reducing pain and disability. in a natural and holistic way.24 The body has an innate ability to “heal itself,” but this ability is compromised in older people, especially those with chronic comorbidities. However, the inclusion of “self-healing” in integrative medicine has the ability to optimize the body’s endogenous repair processes and restore homeostasis.
Minor editing and formatting for review requirements was undertaken by Ella Palmer, PhD, CMPP of inScience Communications, Springer Healthcare Ltd, UK, and was funded by Sanofi.
AM contributed exclusively to the preparation of this commentary.
No specific funding has been sought or obtained in connection with this editorial.
AM is president of the Osteoarthritis Research Society International (OARSI). He has no conflict of interest regarding the publication of this editorial.
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