Musculoskeletal pain encompasses a wide range of muscle and skeletal disorders, which affect millions of Americans every year. Unfortunately, this broad etiology makes the diagnosis and management of musculoskeletal pain particularly challenging for primary care clinicians and specialists alike. A review of the literature reveals that, in the past decade, there have been remarkable advances in the field of pain management, from a better understanding of the basic science to state-of-the-art drug delivery systems. These advances prompt the need for a multidisciplinary review of the diagnosis and treatments available for musculoskeletal pain, in particular for osteoarthritis and low back pain.

To provide practicing pharmacists with a contemporary, evidence-based approach to the management of OA pain in adults, previously published OA-related CPGs, supported by high quality evidence with new findings when appropriate, are synthesized in this review. Although the principal focus is pharmacotherapy, other therapeutic modalities are included, because pharmacists must be able to counsel patients on the range of treatment options available.

The goal of this program is to update nurses’ clinical knowledge of osteoarthritis (OA) and its management.

"Osteoarthritis (OA) is the most common type of arthritis and the major cause of chronic musculoskeletal pain and mobility disability in elderly populations worldwide," write W. Zhang, PhD, from the University of Edinburgh, Osteoarticular Research Group, Queen's Medical Research Institute, Edinburgh, United Kingdom. "Knee and hip pain are the major causes of difficulty in walking and climbing stairs in the elderly in Europe and the USA and as many as 40% of people over the age of 65 in the community in the United Kingdom suffer symptoms associated with knee or hip OA." The objective of these guidelines was to develop concise, current, patient-centered, evidence-based, expert consensus recommendations for the management of hip and knee OA. The panel intended these guidelines to be adaptable and designed them as an aid to clinicians and allied healthcare professionals in general and specialist practice throughout the world.

Chronic pain is a complex disease state, complicated by physical, psychosocial, and spiritual suffering. It has been referred to as the third largest health problem in the world.1 It is estimated that 50 million people experience chronic pain yearly and on average one out of every three people in America will suffer from chronic pain at some point during their life. This number can only be expected to increase with the growing elderly population given that the number of people living with painful conditions (arthritis, cancer, back disorders, rheumatologic disorders, etc.) will be multiplied.

Osteoarthritis is one of the most common causes of disability in older adults. To help patients self-manage their arthritis, nurses need a better understanding of experiences of living with arthritis. Many older adults with symptomatic osteoarthritis may reside in supportive housing such as assisted living facilities. Recognizing challenges and symptoms may lead to improved health and quality of life, as well as greater independence, for older adults with osteoarthritis.

These practice guidelines recommend exercise to relieve the pain of osteoarthritis in older adults.

Fragility fractures are defined as fractures resulting from a fall from a standing height or less, or presenting in the absence of obvious trauma. Fragility fractures affect up to one-half of women and one-third of men over age fifty, and are often associated with low bone density. Such fractures occur most commonly in the hip, spine, and wrist. The dual burdens of suffering and health care costs are enormous for all fracture patients, particularly those with hip fractures. Clinical trials have demonstrated that treatment of patients with fragility fractures can reduce the risk of future fractures by up to 50%. Thus, it is important that these patients not only receive treatment for the presenting fracture, but also for prevention of future fractures. This statement has been endorsed by Endorsed by: American Academy of Orthopaedic Surgeons (AAOS); American Society for Bone and Mineral Research (ASBMR); International Osteoporosis Foundation (IOF); National Organization of Orthopaedic Nurses (NAON); National Osteoporosis Foundation (NOF); Orthopaedic Research Society (ORS); and World Orthopaedic Osteoporosis Organization (WOOO).