EC Orthopaedics

Chronic musculoskeletal and neuropathic pain is a common occurrence in the daily practice of orthopaedic surgeons.

There are several diagnostic approaches and, in most cases, pharmacotherapy and physiotherapy are the golden standard of treatment.

However, in the recent years there is an overuse of opioid and non-opioid pharmacological agents which are highly addictive. Around 10% of US patients suffer from opioid addiction and an unknown number of them from pregabalin addiction. Current statistics for the Kingdom of Bahrain are not available, nevertheless the ministry of health considers pregabalin a controlled medication and prescription from consultant is mandatory in order to dispense from the pharmacy.

It is important to recognize the problem in local communities and internationally and raise awareness regarding the abuse of such medications. Orthopaedic surgeons need to remain vigilant in order to recognize addiction and be well informed and supported by government and private regulatory authorities to control the abuse and offer well designed rehabilitation protocols.

Keywords: Chronic Musculoskeletal; Neuropathic Pain; Opioid Epidemic

1. Ushida “Burdensome problems of chronic musculoskeletal pain and future prospects”. Journal of Orthopaedic Science 20.6 (2015): 958-966.
2. Institute of Health Metrics and Evaluation, Bahrain (2020).
3. “Musculoskeletal Pain” (2020).
4. American Chronic Pain “Neuropathic Pain” (2020).
5. Bhusal , et al. “Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia”. Drug Health care and Patient Safety 8 (2016): 13-23.
6. Vila-Forte. “Tests for Musculoskeletal Disorders”. Merck Manual (2017).
7. Brummet , et al. “Prevalence of the Fibromyalgia Phenotype in Spine Pain Patients Presenting to a Tertiary Care Pain Clinic and the Potential Treatment Implications”. Arthritis Rheumatism 65.12 (2013): 3285-3292.
8. Harvard Medical “Complex Regional Pain Syndrome” (2020).
9. “Osteoarthritis” (2020).
10. Uhl RL., et al. “Management of chronic musculoskeletal pain”. Journal of American Academy of Orthopaedic Surgeons 2 (2014): 101-110.
11. Babadunde O., et al. “Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evi- dence”. Plos One 6 (2017): e0178621.
12. John Hopkins “Opioid Addiction” (2020).
13. Von Korff “Opioids for Chronic Musculoskeletal Pain: Putting Patient Safety First”. Pain 154.12 (2013): 2583-2585.
14. National Institute of Drug “Opioid Overdose Crisis” (2020).
15. American Academy of Addiction “Opioids” (2017).
16. Drug Addiction Treatment (2020).
17. Derry , et al. “Pregabalin for chronic neuropathic pain in adults”. Cochrane (2020).
18. Ohmichi Y., et al. Therapeutic effects of diclofenac, pregabalin, and duloxetine on disuse-induced chronic musculoskeletal pain in rats”. Scientific Reports 8 (2018): 3311.
19. “Pregabalin” (2020).
20. Lyrica (2020).
21. The Guardian (2017).
22. Recovery, Lyrica Withdrawal (2018).