Stakeholder perspectives on musculoskeletal pain assessment and management in the UK: a qualitative study.

Abstract

Background: Musculoskeletal (MSK) conditions, including rheumatic musculoskeletal diseases (RMDs), are leading causes of persistent pain, disability, reduced quality of life, impaired work participation and increased healthcare utilisation. Despite therapeutic advances, pain remains challenging to assess and manage because unidimensional measures may miss multidimensional impact, and person-centred, mechanism-informed, equitable approaches are inconsistently implemented.

Objectives: This study explored stakeholder perspectives on (1) gaps and limitations in current MSK pain assessment; (2) priorities for improving MSK pain management across pharmacological, non-pharmacological, digital and procedural/surgical approaches and (3) service and research priorities needed to deliver equitable, person-centred, mechanism-informed care.

Design: We conducted an anonymised online survey (Google Forms) between July and September 2025 across UK Musculoskeletal Translational Research Collaboration (TRC) networks.

Methods: Adults (⩾18 years) able to read English were invited via TRC mailing lists, partner newsletters and professional networks. Open-ended questions explored experiences of pain assessment and management, perceived gaps and priorities for improvement and research. Free-text responses were exported, cleaned and analysed in NVivo using inductive reflexive thematic analysis (Braun and Clarke), supported by peer debriefing and an audit trail. Descriptive statistics summarised participant roles.

Results: Thirty-five participants responded, with 54.3% patients, 40% healthcare providers and 5.7% researchers. Five overarching themes were identified: (1) appreciation of pain mechanisms to guide management, (2) holistic and person-centred care, (3) need for individualised treatment plans, (4) limitations of current pain assessment methods and (5) underestimation of pain's broader impact. Subthemes highlighted complementary therapies, digital resources and telehealth, self-management education, equitable access, multidomain assessments and clinician capacity to deliver comprehensive biopsychosocial care.

Conclusion: Stakeholders in this TRC-network sample prioritised individualised, holistic and mechanism-informed MSK pain management integrating pharmacological, non-pharmacological and digital strategies while addressing equity and access. Findings support moving beyond single-item intensity measures, strengthening self-management, and adopt biopsychosocial approaches. These hypothesis-generating insights should be validated in broader, more diverse samples.