Behind the Book: Thomas Graven-Nielsen
 Musculoskeletal pain — including fibromyalgia,
work-related myalgia, myofascial pain, strain injuries, low back pain,
and arthritis and other inflammatory conditions of the muscles, tendons,
and joints — is a major medical and economic problem. The newest
book from IASP Press®, Fundamentals of Musculoskeletal Pain,
integrates research findings within the field of musculoskeletal pain
into a comprehensive publication that explores translational aspects
relevant to clinical pain. We asked lead editor Dr. Thomas
Graven-Nielsen to describe why the book is such a unique resource.
Q: What do you consider some of the most exciting areas of
research on musculoskeletal pain?
Graven-Nielsen: The scientific approach in which basic animal
findings are translated into human manifestations is yielding exciting,
new insights into the mechanisms involved in chronic musculoskeletal
pain in patients. This type of new knowledge is fundamental for
developing improved treatments.
Q: Why is there a need for a book on this topic?
Graven-Nielsen: The last few years have seen an extensive number of
original, peer-reviewed publications in this field, so the time is right
for an updated comprehensive overview of the mechanisms of
musculoskeletal pain. Perhaps this book’s most useful and timely
contribution is to highlight the translation of findings from basic
animal studies, and from human experimental pain studies, into potential
clinical mechanisms.
Q: Is the book relevant for clinicians treating
musculoskeletal pain?
Graven-Nielsen: Definitely. Clinicians will find this book a useful
resource to update them on current knowledge about the mechanisms
involved in musculoskeletal pain. Over the past decade, our
understanding of these mechanisms has changed dramatically. Previous
beliefs were adopted from pain research that did not specifically target
deep-tissue pain. Today we know about additional mechanisms that are
only relevant to musculoskeletal pain. This book gives the full picture,
including the functional effects of pain (movement disturbances due to
muscle pain) as well as sensory manifestations (such as referred pain
and hyperalgesia). Several chapters highlight current clinical views on
musculoskeletal pain, including fibromyalgia, clinical aspects of muscle
and joint pain, work-related pain, neck pain, temporomandibular pain,
and low back pain.
Q: Does the book offer any new insights on why
musculoskeletal pain conditions are more prevalent in
women?
Graven-Nielsen: The book presents new views on gender differences in
musculoskeletal pain conditions. It describes evidence for sex-related
differences in muscle afferent responses and estrogen-related modulation
of receptor expression and function. It is still an open issue whether
sex-related differences in muscle afferent discharge contribute to
differences in the incidence and prevalence of chronic myofascial
pain.
Q: Please tell us about the symposium on which this book was
largely based.
Graven-Nielsen: Many of the book chapters are based on presentations
at the 7th IASP Research Symposium, “Fundamentals of
Musculoskeletal Pain,” which took place in May 2007 at Aalborg
University’s Center for Sensory-Motor Interaction [in Denmark]. We
were extremely pleased to see the genuine interest among the 180
participants from around the world and to hear their lively discussions
of the topic during the meeting.
Q: The last section of the book focuses on the effects of
pain on motor function. What are some of the most important clinical
aspects of new insights in this area?
Graven-Nielsen: Researchers had believed that deep-tissue pain
facilitates muscle activity, which was thought to cause more pain,
leading to a vicious cycle. The main new insight on this topic is that
pain has a more adaptive role, so that musculoskeletal pain decreases
muscle activity and range of motion, which will eventually overload
other muscles and structures.
Q: Do you have any words of encouragement on potential novel
therapies for clinical pain?
Graven-Nielsen: Many contributions to this book highlight the
importance of facilitation in central neural mechanisms of
musculoskeletal nociception, such as the widespread allodynia that
occurs in animal models of muscle nociception and enlarged areas of
referred pain in patients with chronic musculoskeletal pain. These new
insights on plasticity might guide the development of novel targeted
treatment regimes. The book explains that some of the pain
manifestations in chronic musculoskeletal pain conditions are
consequences of sensitization. Some of the management strategies used to
manage neuropathic pain also apply to chronic musculoskeletal pain
conditions. This concept is slowly being clinically accepted, and the
drugs used in neuropathic pain are being used in conjunction with
traditional musculoskeletal pain management regimes.
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