Persistent musculoskeletal pain: osteoarthritis, tendinopathies, and myofascial pain

Persistent musculoskeletal pain represents the most prevalent cause of chronic pain worldwide. Osteoarthritis, chronic tendinopathies, and myofascial pain syndrome constitute the most common clinical entities involved in this phenomenon. The understanding of chronic pain has evolved substantially. Whereas it was previously conceptualized within a purely structural-degenerative framework, it is now recognized as a complex and integrative process involving peripheral sensitization, central sensitization, neuroinflammation, and dysfunction of descending modulatory systems, all of which contribute to pain amplification and persistence. This paradigm shift necessitates diversified and mechanism-based therapeutic approaches. The objective of this article is to integrate the pathophysiology of persistent musculoskeletal pain with targeted therapeutic strategies, proposing a multimodal approach to the management of persistent musculoskeletal pain.