Implementing a low-dose radiation therapy program for musculoskeletal pain disorders: tips, tricks, and essentials for clinical researchers.

Introduction: Painful musculoskeletal disorders (PMDs) represent an increasing public health concern, particularly among aging populations. When conservative therapies prove insufficient, low-dose radiotherapy (LDRT) has emerged as a non-invasive and effective treatment alternative. Despite growing clinical evidence supporting its efficacy, LDRT remains underutilized due to persistent skepticism and the absence of standardized clinical guidelines.

Materials and methods: This review synthesizes current evidence on the use of LDRT for PMDs, focusing on its biological mechanisms, optimal dosing regimens, clinical efficacy, and safety profile. Attention is given to dose fractionation strategies, timing of re-irradiation, and technological advancements that enhance treatment precision.

Results: LDRT provides pain relief in 60-90% of treated cases, with the most favorable results achieved using fraction doses between 0.3 and 0.7 Gy. Its anti-inflammatory effects are mediated through immune modulation, reduced proinflammatory cytokine expression, and promotion of tissue repair. Re-irradiation performed 10-12 weeks after the initial cycle may be beneficial in patients experiencing symptom persistence or recurrence. Long-term follow-up data confirm sustained efficacy and indicate a minimal risk of radiation-induced malignancies in older adults.

Conclusion: LDRT is a safe and effective treatment option for PMDs, especially in patients unresponsive to conventional therapies. To facilitate its broader adoption, this review underscores key clinical evidence and proposes practical considerations for integrating LDRT into multidisciplinary pain management protocols.