Towards a mechanisms-based classification of pain in musculoskeletal physiotherapy?

The purpose of this article is to review the case for the inclusion of a mechanisms-based classification for musculoskeletal pain. In response to perceived limitations of the medical/disease model of pain and illness a mechanisms-based classification system for pain has been advocated. The classification of pain according to the underlying neurophysiological mechanisms responsible for its generation and/or maintenance may better explain the variability and complexities of clinical presentations of musculoskeletal pain and facilitate subsequent decision-making associated with the assessment, treatment and prognosis of patients with musculoskeletal disorders. However, current methods of mechanisms-based classification either lack standardised criteria or propose decision rules whose validity has yet to be substantiated empirically. While the case for a mechanisms-based classification for pain has been well made the onus rests with its advocates to (a) establish its validity for use in clinical practice in defined populations with musculoskeletal disorders, and (b) provide evidence that such a system facilitates improved clinical outcomes.