Enfrentamiento del paciente con dolor musculoesquelético / Confrontation of patient with musculoskeletal pain

ABSTRACT

Primary musculoskeletal pain consultation is high, and physicians are faced with a number of challenges. One of these is to differentiate between diseases that present similar symptoms, some potentially serious that leave sequelae and limitations, and other that are less severe but more frequent and affect patient's everyday life. Another challenge is early diagnosis in order to avoid greater damage. In order to deal with these problems, doctors must have adequate training and skills that allow them to differentiate the origin of the pain, i,e, if the pain is articular or not, or if is origin does not stem from the muscular and skeletal system. Diagnosis must also include if manifestations are localized or generalized, axial or peripheral, inflammatory or non inflammatory, acute or chronic; if the manifestation is a mono, oligo or polyarthropathy. Together with this, physicians must be aware of the extraskeletal manifestations of rheumatic diseases, such as general manifestations or involvement of diverse systems that are fundamental when diagnosing inflammatory rheumatisms. Moreover, clinical doctors must know how to used and correctly interpret the studies of articular fluid, general and correctly interpret the studies of articular fluid, general and immunological laboratory, and images, always oriented to the patient's clinical manifestation. Once these parameters have been defined, they must be syndromatically sorted in order to prepare a specific diagnosis and consequently offer the patient the most adequate pharmacological and non pharmacological treatment for each case.