Revisiting chronic musculoskeletal pain as a biopsychosocial disorder

Table 1 Overview of major findings and their interpretive significance in chronic musculoskeletal pain

Key finding	Findings in Hamed et al[12] study	Interpretative implication	Interpretation boundary
Female predominance	Female patients accounted for 81.25% of the cohort	Suggests potential biological, psychosocial, and gender-related influences on susceptibility to chronic musculoskeletal pain	Female predominance alone does not establish hormonal or sex-specific biological mechanisms
High psychiatric comorbidity	Depression (37.5%) and anxiety (43.75%) were highly prevalent	Reinforces the biopsychosocial model by highlighting the close association between psychological distress and chronic musculoskeletal pain	The cross-sectional design does not determine whether psychiatric symptoms are causes, consequences, or mutually reinforcing factors
Prominent sleep disturbance	Clinically significant insomnia was reported in 87.5% of patients	Supports the concept of reciprocal interactions between sleep disturbance and chronic musculoskeletal pain	The temporal relationship between insomnia and pain cannot be determined from the available data
High burden of life stressors	Financial and occupational stressors (75%) and marital problems (60%) were common	Suggests that psychosocial stress may contribute to pain vulnerability and persistence	Associations do not demonstrate that psychosocial stress directly initiates or chronifies pain
Maladaptive coping strategies	Self-blame, denial, and behavioral disengagement were frequently reported	Highlights the potential contribution of cognitive and behavioral factors to pain perception and disability	Coping strategies were self-reported and should not be interpreted as causal determinants of persistent pain
Impaired quality of life	WHOQOL scores were substantially reduced in the physical, psychological, and social domains	Demonstrates the broad multidimensional burden of chronic musculoskeletal pain on daily functioning and well-being	Reduced quality of life reflects disease burden but does not identify the underlying biological mechanisms
Central sensitization	The combination of psychological distress, insomnia, maladaptive coping, and widespread symptom burden is compatible with a centrally amplified pain phenotype	Suggests that some patients may exhibit clinical features consistent with central sensitization	The study did not include quantitative sensory testing, neuroimaging, pain-threshold assessment, or mechanistic biomarkers; therefore, central sensitization cannot be confirmed
Lack of immunological assessment	No inflammatory biomarkers, cytokines, or infectious parameters were evaluated	Identifies an important knowledge gap and supports future multidisciplinary studies integrating biological and psychosocial assessments	Immune activation, neuroinflammation, and infection-related mechanisms cannot be inferred from the available data

WHOQOL: World Health Organisation Quality of Life.