Musculoskeletal pain on the global stage: what next?

In this essay, we describe two recent developments in global public health efforts in the chronic pain field and use the example of musculoskeletal pain to explore some of the implications arising from these developments. The first is the recognition of chronic pain as a condition in its own right, which has been the impetus for several national and one recent international pain summits that have translated that into a call for recognition, rights and resources for people with pain. The other development is the first comprehensive attempt to measure the global burden of musculoskeletal conditions in the current round of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2010). In essence, the task here has been to translate epidemiological data from all countries where data are available into standardised measures of the overall burden of musculoskeletal conditions to allow comparison of the burden relative to other conditions, and to identify the proportion of the burden that is attributable to a set of common risk factors. Past rounds of the GBD have been influential in priority setting and allocation of health funding by the World Health Organisation and national governments. The current GBD 2010 Study is occurring in the context of changes in thinking about how to fund health care in a global context. These changes are away from disease-specific programmes to more 'integrated' approaches, and thus represent a potential challenge to the calls to consider pain-focussed funding. We explore the strategic implications of both of these developments for translating our better understanding of the problem of musculoskeletal pain into effective policy action.