The influence of verbal suggestions in the management of musculoskeletal pain: a narrative review

Background: Pain has been considered to be the most disabling symptom of musculoskeletal disorders. It is the cause of a large number of medical consultations and high health costs around the world. Chronic back pain affects a larger population than other types of pain, with observed prevalence of between 53% and 81%; this has economic, clinical and social repercussions for the health system. Objective: The purpose of the present article is to describe the utility and the neurobiological mechanisms of verbal suggestion as a therapeutic ally during the management of patients with musculoskeletal pain. Important discoveries: Inducing expectations by means of verbal suggestions can activate placebo or nocebo pathways when the clinical professional uses either positive or negative words respectively. When the administration of drugs and physiotherapy interventions are accompanied by words which induce positive expectations, this may improve certain clinical parameters such as pain and/or function in people suffering low back pain. Equally important, the use of positive verbal suggestion may decrease the perception of pain in patients with osteoarthritis. Conclusions: In the management of clinical musculoskeletal pain, the inclusion of verbal suggestion has the potential to induce expectations which may generate hypoalgesia through the placebo effect; however, more research is needed to determine the magnitude and clinical significance of this contribution.