Open research questions in Musculoskeletal pain and rehabilitation

What the literature leaves open

• One challenge is the limited understanding of the effects of restorative neurostimulation on lumbar multifidus muscle morphology. Another challenge is the difficulty in measuring changes in muscle morphology using MRI scans. A third challenge is the potential bias in the patient cohort, as patients who had undergone prior open lumbar spinal surgery had significantly worse baseline multifidus scores.

  Lumbar multifidus muscle morphology on MRI after restorative neurostimulation for chronic low back pain: a single centre case series using the Goutallier classification · 2026 · DOI

• The study must ensure the reliability and validity of the QBPDS-AR scale. The study needs to address potential biases in the recruitment of consecutive patients from outpatient orthopedic clinics.

  Translation, cross-cultural adaptation, and validation of the Arabic Quebec Back Pain Disability Scale (QBPDS-AR) for patients with lower back pain: a prospective cross-sectional observational study · 2026 · DOI

• Prior work has been limited to the lumbar spine. The use of fluoroscopy has limited sample sizes due to radiation exposure. There is a lack of understanding of anti-directional segmental motion in the thoracolumbar spine.

  Anti-directional segmental motion during flexion and extension in the adolescent thoracolumbar spine: a normative study of 166 participants · 2026 · DOI

• The review notes the challenge of limited attention to the factors influencing referral decisions and their impact on referral pathways.

  Factors influencing referral decisions for patients with chronic low back pain: a scoping review · 2026 · DOI

• Further research is needed to address the gaps in current research. Studies should investigate the effectiveness of interventions on referral decisions in CLBP care. Research should focus on establishing causal relationships between factors influencing referral decisions and patient outcomes.

  Factors influencing referral decisions for patients with chronic low back pain: a scoping review · 2026 · DOI

• The relationship between Modic changes and chronic low back pain is not fully understood. The clinical relevance of Modic changes in symptomatic individuals is unclear. The impact of lifestyle and mental health factors on Modic changes and chronic low back pain is not well studied.

  Modic changes, chronic low back pain, and lifestyle and mental health factors: a cross-sectional analysis of a cohort study · 2026 · DOI

• The gap in the literature is the lack of understanding of the multidimensional heterogeneity among adults with chronic low back pain. The study aims to address this gap by identifying exploratory biopsychosocial profiles and examining sociodemographic and anthropometric characteristics.

  Exploratory Biopsychosocial Profiles in Adults with Chronic Low Back Pain: A Cluster Analysis of Clinical, Psychological, Sleep, and Physical Characteristics · 2026 · DOI

• Lack of understanding about how task engagement affects pain attenuation. No established method to capture individual differences in pain attenuation during tasks. Need for a new scoring system to address this gap.

  Pain attenuation during task: a proof-of-concept study for a new scoring metric to capture individual differences in chronic pain changes by task engagement · 2026 · DOI

• The available pharmacological treatments for CLBP often do not successfully resolve the pain. There is a need for more comprehensive treatments that aim to reduce the pain and functional limitations associated with CLBP.

  Patient Experiences of Chronic Low Back Pain: Development of a Conceptual Model Based on a Targeted Literature Review and Qualitative Patient Interviews · 2026 · DOI

• Conventional clinical neck assessments may not accurately reflect functional limitations experienced during activities of daily living. There is a need for a more accurate and comprehensive assessment of neck functional status.

  Neck Functional Status Assessment Using Virtual Reality Simulation of Daily Activities · 2025 · DOI

• The lack of controlled lighting conditions during acquisitions made with mobile devices. The potential bias introduced by using only one printer to print all artificial pain drawings. The challenge of comparing the performance of the platform with other existing methods due to the specificity of body charts for each app.

  Automated Pain Spots Recognition Algorithm Provided by a Web Service–Based Platform: Instrument Validation Study · 2024 · DOI

• The lack of a standardized method for scanning pain drawings. The need to validate the usability and reliability of digital pain drawings. The limited understanding of the effectiveness of digital pain drawings in clinical settings.

  Automated Pain Spots Recognition Algorithm Provided by a Web Service–Based Platform: Instrument Validation Study · 2024 · DOI

• There is a lack of understanding of the factors influencing adherence to home-based exercise therapy in adults with non-specific chronic low back pain. Prior studies have reported varying adherence rates, and the effect of supervision on adherence is not well understood. The study aims to address this gap by investigating adherence and associated factors.

  Adherence to home-based exercise therapy in adults with non-specific chronic low back pain: a cross-sectional study of 491 participants of the ComPaRE cLBP e-cohort (ADHERE II) · 2026 · DOI

• Future research should examine its clinical utility, such as in matching patients to pain mechanism-targeted treatments.

  Nociplastic Questionnaire (NociQ) · 2026 · DOI

• The relationship between spinal mobility and trunk strength in children is not well understood. There is a lack of studies examining the relationships between spinal mobility, speed, and strength in schoolchildren.

  Global spinal mobility shows no consistent association with trunk strength in children: a school-based cross-sectional study · 2026 · DOI

• Future work should focus on developing a conceptual framework and item generation, cognitive debriefing and validation, and psychometric evaluation in larger and more diverse samples ensuring reliability, validity, and applicability of the final patient-reported outcome measure across clinical and research settings.

  Eliciting a Conceptual Model for a New Patient-Reported Outcome Measure to Assess Patients’ Perception of Treatment Goal Achievement in Interdisciplinary Multimodal Pain Treatment · 2026 · DOI

• The study had a relatively small sample size for some profiles. The study was a retrospective cross-sectional analysis. The analysis was limited to patients with low back pain.

  Biokinetic insights into the hip–spine relationship: no correlation between hip strength or flexibility and altered pelvic motion in patients with low back pain · 2026 · DOI

• Investigate the hypothesis that altered pelvic kinematics reflect a compensatory strategy to limit lumbar movement. Explore the relationship between hip muscle characteristics and dynamic pelvic parameters in other patient populations.

  Biokinetic insights into the hip–spine relationship: no correlation between hip strength or flexibility and altered pelvic motion in patients with low back pain · 2026 · DOI

• The study notes that correlation alone does not imply equivalence of measurement.

  Are pain intensity measures interchangeable? agreement among ODI, SRS-22, and COMI in chronic low back pain with and without scoliosis · 2026 · DOI

• CLBP is inclusive of a broad and heterogeneous patient population; thus, the characteristics of patients described in the TLR studies and of those who participated in qualitative interviews were not identical. The TLR was targeted and results were limited to work published between 2013 and 2023; thus, some publications may have been inadvertently missed during study identification.

  Patient Experiences of Chronic Low Back Pain: Development of a Conceptual Model Based on a Targeted Literature Review and Qualitative Patient Interviews · 2026 · DOI

• Despite its prevalence, leg weakness in people with sciatica is poorly characterised using existing clinical measures.

  CLINICAL UNCERTAINTY AMONG HEALTH PROFESSIONALS WHO ASSESS PEOPLE WITH SCIATICA AND LEG WEAKNESS: RESULTS OF AN ONLINE SURVEY · 2026 · DOI

• Further research is needed to assess the responsiveness of the QBPDS-AR to change over time, - Studies should be conducted to compare the QBPDS-AR to other measures of back pain disability, - Research should be done to evaluate the use of the QBPDS-AR in different clinical and research…

  Translation, cross-cultural adaptation, and validation of the Arabic Quebec Back Pain Disability Scale (QBPDS-AR) for patients with lower back pain: a prospective cross-sectional observational study · 2026 · DOI

• Further studies could investigate the reasons behind the quantitative discrepancies among pain measures, - Research could explore the use of different statistical methods to compare pain measures, - Studies could examine the agreement among pain measures in different…

  Are pain intensity measures interchangeable? agreement among ODI, SRS-22, and COMI in chronic low back pain with and without scoliosis · 2026 · DOI

• The study used a specific population-based mobile health study, - The study assumed that the outcome variable was on a continuous scale in one of the sensitivity analyses, - The study used a specific algorithm for clustering, - The study had a limited number of participants in the transition…

  Identifying Weekly Trajectories of Pain Severity Using Daily Data From an mHealth Study: Cluster Analysis · 2024 · DOI

• Investigate the relationship between supervision and adherence, - Examine the impact of physical activity before the onset of cLBP…

  Adherence to home-based exercise therapy in adults with non-specific chronic low back pain: a cross-sectional study of 491 participants of the ComPaRE cLBP e-cohort (ADHERE II) · 2026 · DOI

Most-cited papers in Musculoskeletal pain and rehabilitation

• What low back pain is and why we need to pay attention · The Lancet · 2018 · 3,912 citations
• Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms · Applied Ergonomics · 1987 · 3,677 citations
• RULA: a survey method for the investigation of work-related upper limb disorders · Applied Ergonomics · 1993 · 2,455 citations
• Epidemiological features of chronic low-back pain · The Lancet · 1999 · 2,406 citations
• Non-specific low back pain · The Lancet · 2016 · 2,177 citations
• Prevention and treatment of low back pain: evidence, challenges, and promising directions · The Lancet · 2018 · 1,994 citations
• The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence · Journal of Behavioral Medicine · 2006 · 1,780 citations
• Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021 · The Lancet Rheumatology · 2023 · 1,558 citations
• Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017 · Annals of Translational Medicine · 2020 · 1,329 citations
• Expenditures and Health Status Among Adults With Back and Neck Problems · JAMA · 2008 · 1,230 citations

Most recent work

• Spinal manipulative therapy for adults with chronic low back pain · Cochrane Database of Systematic Reviews · 2026
• Towards global clinical practice guidelines for the management of non-specific low back pain in primary care: a review of current guideline recommendations and how they have changed over the last 30 years · The Lancet Rheumatology · 2026
• Spine-centred integrated osteopathic management for multi-site degenerative musculoskeletal pain after conventional and traditional healing failure in a low-resource setting: a concept-driven case report · Frontiers in Musculoskeletal Disorders · 2026
• The impact of social support on pain intensity in older adults with chronic pain: the serial mediating roles of positive and negative affect and pain catastrophizing · BMC Geriatrics · 2026
• Directrices en la aplicación de la guía de práctica clínica en la lumbalgia · Cirugía y Cirujanos · 2026
• Global prevalence, incidence, and years lived with disability (YLDs) of osteoarthritis: trends from 1990 to 2021 and projections to 2050 · Journal of Orthopaedic Translation · 2026
• Prevalence, burden, and factors associated with chronic pain and high-impact chronic pain in U.S. Adults, 2019–2023 · Journal of Pain · 2026
• The Impact of Preoperative Psychological Interventions on Postoperative Outcomes in Spine Surgery · Clinical Spine Surgery A Spine Publication · 2026
• COMPARING THE THICKNESS OF STERNOCLEIDOMASTOID MUSCLE IN INDIVIDUALS WITH FORWARD HEAD POSTURE AND NORMAL HEAD POSTURE · DOAJ (DOAJ: Directory of Open Access Journals) · 2026
• Ergonomic risks in healthcare workers in acute care; the POSTURE framework · Injury · 2026

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