Chronic pain: the role of psychosocial factors in common musculoskeletal disorders

Common musculoskeletal disorders have an impact on society and the economy, and contribute towards a significant amount of sickness absence. In this paper we emphasize the key role of psychosocial factors in causing and maintaining common musculoskeletal disorders, and illustrate this with reference to research carried out in the last 10 years. Diagnostic criteria for one of these musculoskeletal disorders (fibromyalgia) have been heavily criticized, and recently alternative criteria have been proposed which identify a more homogeneous group with greater fatigue, sleep disturbance and psychosocial distress. This disorder has been called chronic widespread pain (CWP), and evidence suggests that it is best understood as a somatoform disorder. In these patients consulting behaviour is often influenced by factors affecting the ability to cope, such as relationship difficulties or occupational factors. Other common regional musculoskeletal disorders such as whiplash neck injury and repetitive strain injury (RSI) are also discussed. Finally, we address the ways in which psychosocial factors shape the presentation of musculoskeletal disorders in the work place, and provide suggestions about how these disorders can be assessed and managed.