Review Article

The Role of Pre-nociceptive Mechanical Factors in the Physiopathology of Musculoskeletal Pain

Mauro Nicolás Guzzardo¹, Duilio Román Guzzardo², Pedro Iván Arias-Vázquez³

• Rehabilitation Medicine, Pain Medicine. Pain Research and Training Team (EFID), National University of Rosario, Argentina
• Rheumatology, Family Medicine. Pain Research and Training Team (EFID), National University of Rosario, Argentina
• Rehabilitation Medicine, Sports Medicine. Department of Rehabilitation, Juarez Autonomous University of Tabasco, México

---

Keywords: Mechanical overload, Musculoskeletal dysfunction, Musculoskeletal overload, Musculoskeletal pain, Pre-nociceptive factors

---

Abstract

Musculoskeletal pain represents an important cause of medical care and disabilities worldwide. The pathophysiology of musculoskeletal pain of mechanical origin is divided into 4 phases that include the pathophysiological mechanisms from the activation of the nociceptors to the reception and interpretation of the nociceptive stimulus in the cortical centers. However, there are factors that precede nociceptive activation, which we have called pre-nociceptive mechanical factors. The objective of this manuscript is to establish a theoretical framework on the implications that pre-nociceptive mechanical factors have in the origin and perpetuation, as well as the management of musculoskeletal pain. Mechanical overload and functional alteration of the musculoskeletal system are factors that precede and may favor the activation of the nociceptive cascade. Mechanical overload occurs when the magnitude of the load exceeds the capacity of the musculoskeletal system. Likewise, a dysfunctional musculoskeletal system has a poor adaptive capacity to the mechanical loads it faces and this predisposes it to generate functional compensations; in both cases, tissue overload, micro-structural damage, inflammation, tissue sensitization and tissue degeneration or macro-structural damage may occur in the long term. Both factors must be considered when implementing therapeutic strategies for the prevention and treatment of musculoskeletal pain of mechanical origin.

---