Exploring clinical care pathways of individuals with comorbid mental health disorders after presenting to emergency due to acute musculoskeletal pain: A Narrative Review

Complex Musculoskeletal (MSK) pain conditions are the leading cause of Years Lived with Disability (YLD) globally [1]. Alarmingly, this has remained the same since 1990 [2] suggesting that research into prevention and rehabilitation of MSK pain over the past 25+ years has had limited effect on its overall global burden. The reasons some fail to report full recovery while others follow a less problematic recovery trajectory are becoming clearer with psychological predictors (anxiety, depression, stress) showing some prognostic value [3]. Effective interventions however have proven elusive. Treatment of chronic MSK pain in many clinical settings tends to focus on the physical modalities such as pharmacologic, surgical, and other physical therapies excluding holistic interventions targeting psychosocial causes [4]. An integrative approach towards assessing and effectively managing a patients pain should cover the physical, behavioural, and psychosocial drivers of the patients pain experience. Moreover, a better understanding of the myriad of biopsychosocial mechanisms driving the clinical course for each patient seems particularly germane to the acute care encounter, given the current challenges with pharmaceutical dependence and overutilisation of and reliance on diagnostic tests that rarely inform management; or worse, promote ineffective management.