Published: 8.1.2026
Text: Eveliina Heikkala
Editing: Viestintätoimisto Jokiranta Oy
Image: Shutterstock

Pain is not only a physical phenomenon. It originates and is interpreted within our nervous system, and the experience of both short and long-term pain is multidimensional and individual. Long-term pain – usually called persistent pain – is pain that lasts for over three months, which is longer than it usually takes to recover from a tissue injury. Persistent pain does not develop in a haphazard manner. Rather, the risk of the pain becoming persistent is affected by a number of factors – particularly, their co-occurrence. The risk is increased by

• biological factors (e.g., genetic factors),
• psychological factors (e.g., negative thinking and beliefs of pain),
• social factors (e.g., poor financial situation),
• work-related factors (e.g. , heavy or long-term mental and physical loading),
• lifestyle (e.g., insufficient sleep and physical activity), and
• co-morbidities (e.g., depression, obesity).

These are key factors independent of the cause of musculoskeletal pain, that is, regardless of whether or not there is an underlying mechanical or structural reason (such as, joint degeneration). The above-mentioned factors may also determine, how severe or disabling the pain experience becomes. Many people who have experienced pain have likely noticed that pain is more tolerable during less stressful periods and after a good night’s sleep than in a mentally or physically loading life situation with possible sleep deprivation.

Towards more individualised care and rehabilitation

Musculoskeletal disorders are primarily treated conservatively, that is, without surgery. In some cases, surgical treatment is an excellent symptom-relieving solution, but the majority of persons suffering from long-term pain will not gain any help from surgery. At worst, their symptoms may even be aggravated by the operation. The role of rehabilitation is central.

The impact of various rehabilitative measures on the treatment outcomes in musculoskeletal disorders has been extensively studied, with a particular focus on physiotherapy, which is the cornerstone of musculoskeletal rehabilitation. While it is important to explore and define general principles and guidelines, we must not ignore the fundamental fact that we are individuals and our pain experiences are always personal. Thus, it is motivated to assume that we could achieve better and more lasting treatment outcomes by taking the individual into consideration more holistically.

A holistic approach is already being applied in the treatment of, for instance, type 2 diabetes, but, for now, no such model exists for the treatment of musculoskeletal disorders. We know that the risk of cardiovascular events in patients with type 2 diabetes will decline when the various risk factors (blood sugar, blood pressure, cholesterol, smoking etc.) are effectively under control. It is essential for healthcare professionals to assess the key risk factors and evaluate the therapeutic balance of measurable risk factors and, together with the patient, draw up a collaborative plan for care and treatment by taking into account the aspects that are meaningful for the patient as well as the individual resources and life situation. The holistic and individual approach is stressed in the national Current Care Guideline for Low Back Pain, but there is a need for additional scientific evidence on the matter.

The research project is comprehensive

The aim of our research project is to develop a new treatment model for primary healthcare to assist physiotherapists in identifying lifestyle and psychological factors as well as co-morbidities that contribute to the individual’s pain experience and the risk of persistent pain, and in guiding the patients to relevant treatments. In practice, this means that, in addition to physiotherapy, patients would be offered individually tailored activities that take into account their life situation, thoughts and desires, while also drawing advantage from existing care pathways. The outcomes of patients treated with this model will be compared to those of patients for whom the model is not implemented.

The research project is very comprehensive: it examines treatment outcomes from the patients’ perspective and evaluates the implementation of the new treatment model and factors affecting it at both healthcare professional and unit levels. Based on the feedback, the model will be reshaped for better applicability in daily clinical work, if needed. We expect our research project to enhance professionals’ and patients’ understanding of pain as a holistic phenomenon as well as their knowledge of individualised treatment and care of musculoskeletal pain. The cost-effectiveness of rehabilitation will also be considered in the research.

The study of this important topic is being facilitated by the grant awarded by the Sakari Alhopuro Foundation, for which I am grateful.

 

 

 

Eveliina Heikkala, M.D., Ph.D., is a Specialist in General Medicine and Adjunct Professor in Clinical Epidemiology. She is employed as a post-doctoral researcher at the University of Oulu and as a specialist within the Wellbeing Services County of Lapland. Heikkala is a member of a national research group aimed at developing the treatment and rehabilitation of musculoskeletal disorders. Her team focuses on the study of pain predictors and their management, in particular, and the treatment of chronic pain within primary healthcare, in general.