575: The hidden pain: importance of the myofascial and mixed pain in a orthopedic setting public hospital

Topic: Education, Societal Impact, and Others
Subtopic: Epidemiology

Background and Aims: Myofascial pain syndrome (MPS) is a common but often “hidden” contributor to chronic musculoskeletal and neuropathic pain, characterized by trigger points causing local and referred pain, functional limitation and weakness. Despite being reported in up to 85% of adults over the lifetime, it is frequently underrecognized in orthopedic settings, because its manifestations overlap with joint disorders, fibromyalgia, neuropathic pain and other conditions of chronic pain, partly due to the diagnostic criteria are essentially clinic. Chronic pain commonly presents as mixed phenotypes, with myofascial and neuropathic components influencing the adequate treatments. However, data in Latin American populations remain limited.

Methods: A retrospective observational study was conducted through review of medical records of patients admitted between January and December 2025 at an Interdisciplinary Pain Clinic of a quaternary teaching public hospital in São Paulo, Brazil, if referred from outpatient clinics of the hospital’s Orthopedics Institute. Demographic characteristics, clinical diagnoses, prior treatments, and clinical outcomes were collected. Data were analyzed to characterize the pain profile, associated comorbidities, and patterns of pharmacological management in this population with severe chronic pain.

Results: Ninety patients were evaluated, and 69 (71.0%) were diagnosed with MPS (55.6% women), aged 15–80 years (mean 48.3). Pain referred as lower limbs in 24.6%, axial region in 34,8%, and upper limbs and scapular regions in 40.6%. Mixed pain occurred in 42.3%, neuropathic component was observed in 62%; 20% had other articular diseases and nociplastic pain in 6% of the patients. Non-restorative sleep (70%), physical inactivity (74,4%), mood impairment (77,8%), trauma (48,9%), and postsurgical status (63,3%) were observed. Among MPS patients, 57,8% used opioids; overall, 53,3% used antidepressants and 52,2% anticonvusants as gabapentin, although only 26% had neuropathic pain.

Conclusions: Patients referred from orthopedic clinics showed a high prevalence of chronic myofascial pain, frequently accompanied by mixed pain mechanisms, mood impairment, sleep disturbance, and physical inactivity. Pharmacological management was often misaligned with pain mechanisms, as opioids and anticonvulsants frequently used despite limited or absence of neuropathic components of the pain. These findings highlight the importance of comprehensive pain assessment and mechanism-based treatment strategies in the quaternary care settings, to improve the results and lessen side effects of pharmacological approaches, commonly referred, and to facilitate the rehabilitation of these patients.

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Presenting Author: Mariana Alcantara Roldi de Azeredo
Submitting Author: Mariana Alcantara Roldi de Azeredo

Senior Author: Lin Tchia Yeng

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Renan Wilian Sperandio - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Rodney Junqueira Pereira - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Rosiara Gonçalves Santos - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Débora F R Haidinger Ramos - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Daniel Ciampi de Andrade - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Lin Tchia Yeng - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Alberto Iobbi Júnior - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Flavia Farah Sabe - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Gabriel Taricani Kubota - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• André Cicone Liggieri - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Manoel Jacobsen Teixeira - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Ana Carolina Brighi - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Nancy Yonekawa - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Lucas Pacini - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Camila Gardin de Bello - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Luiz Fernando Alvez - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Barbara Muller - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)
• Ana Mércia Barbosa Leite Fernandes - Pain Clinic of the Orthopedics Institute, School of Medicine, University of São Paulo (FMUSP)