613: Tiered management of work-related musculoskeletal disorders: A Southeast Asian expert framework

Topic: Education, Societal Impact, and Others
Subtopic: Education of pain care

Background and Aims: Work-related musculoskeletal disorders (WMSDs) are a leading cause of work disability, accounting for around 30–50% of occupational illnesses and 2% of the gross domestic product in terms of economic costs, but region-specific guidance in Southeast Asia remains limited. Clinicians often rely on a patchwork of condition-specific guidelines and occupational standards, resulting in fragmented care and under-recognition of work-related factors. A multidisciplinary expert panel from Singapore, Malaysia, Thailand, the Philippines, and Indonesia developed practical, regionally relevant recommendations. This abstract describes a tiered framework for screening, diagnosis, treatment, referral, and return-to-work (RTW) planning for patients with WMSDs in Southeast Asia.

Methods: A multidisciplinary panel of 14 experts from five Southeast Asian countries (occupational medicine, neurology, orthopedics, pain medicine, rehabilitation, rheumatology, and pharmacology) participated. A pre-meeting survey characterized local burden, practice patterns, and barriers across the WMSD care continuum. Panel discussions integrated survey findings with a targeted review of international and regional guidelines. Through structured discussions, the group defined seven core screening questions, practical assessment tools, and a tiered framework stratified by symptom duration into acute (pain lasting 0–6 weeks), subacute (6–12 weeks), and chronic (>12 weeks), covering pharmacologic and non-pharmacologic options, referral triggers, and structured RTW pathways.

Results: Acute WMSD management should prioritize multimodal treatment for pain relief, using pharmacologic agents such as NSAIDs, paracetamol, and skeletal muscle relaxants (e.g., eperisone), complemented by rehabilitation, ergonomic modification, and multidisciplinary team (MDT) involvement to support RTW. Subacute WMSD care aims to prevent chronicity and restore function using core therapies plus judicious adjuvant agent use for neuropathic or mixed pain, rehabilitation, and workplace-focused interventions, with specialist referral and imaging when recovery plateaus. Chronic WMSD management emphasizes long-term pain control, sustainable work participation, structured self-management, and vocational rehabilitation, with cautious escalation and planned deprescribing within MDT-led referral pathways appropriate for Southeast Asia.

Conclusions: This Southeast Asia–focused framework offers pragmatic guidance to harmonize WMSD care across diverse healthcare and occupational settings. By emphasizing early recognition of work-related factors, multimodal treatment, and coordinated multidisciplinary referral and return-to-work planning, it aims to reduce the risk of progression to chronic disability and support sustainable work participation. Implementation requires clinician education, integration into local protocols, and collaboration with employers and policymakers. Future work should pilot the framework, collect real-world data, and refine recommendations to inform regional clinical pathways and policy.

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Presenting Author: Dr Kok-Yuen Ho
Submitting Author: Kok-Yuen Ho

Senior Author: Dr Kok-Yuen Ho

IASP 2026 Global Year theme of Neuropathic Pain: No

• Jimmy Alexander: MD, MM, MSc - Persahabatan Hospital – Pembangunan Nasional University, Indonesia; Budhi Dharma Neuro Pain Clinic, Indonesia
• Roselle Andres: MD, FPCOM - Allied Care Experts Medical Center, Valenzuela City, Philippines
• Mohd Yazid Bin Bajuri: MD (UKM), MS Orth (UKM), MSc Diabetic Science (Warwick University), PhD Visual Informatics (UKM) - Hospital Canselor Tuanku Muhriz, Malaysia
• Chan Kin Yuen: BMedSci (Nott), BMBS (Nott), FRCS (Glasg), FRCS (Tr & Orth), CCST (UK), AAM - Orthopaedic Specialist Centre, Selangor, Malaysia
• Alex Hor Chin Kok: MD (UKM), Anaes & Critical Care (UKM), Academy of Medicine (Malaysia), FIPP (USA), CIPS (USA), FIPM (India), FMUPM (India) - Mawar Medical Centre, Malaysia
• Danaithep Limskul: MD - Chulalongkorn University, Thailand; King Chulalongkorn Memorial Hospital, Bangkok, Thailand
• Rima Melati Harjono: MD, MKK, SpOk, SpAk - President University, Indonesia; Rumah Sakit Umum Pekerja (Worker's General Hospital), Jakarta, Indonesia
• Radite Nusasenjaya: MD, MKK, SpOk - President University, Indonesia
• Thipachart Punyaratabandhu: MD - Phramongkutklao Hospital, Bangkok, Thailand
• Reynaldo R. Rey-Matias: PTRP, MD, MSHMS, FPARM, DPBPM - St Luke's Medical Center, Philippines
• Chuthamanee Suthisisang: BPharm, PhD (Pharmacology) - Chulabhorn Royal Academy, Thailand
• Michelle Mui Hian Teo: NA - DKSH, Singapore
• Tun Myint Win: MBBS - DKSH Management (Thailand) Ltd.
• Evan Glenn S. Vista: MD - St Luke's Medical Center, Philippines; St Luke's College of Medicine, Philippines
• Yoon Kam Hon: MBBS (Singapore), MRCP (UK), MMED (INT MED), FAMS - El Shaddai Arthritis & Rheumatism Specialist Medical Centre, Singapore