Effects of Using Text Message Interventions for the Management of Musculoskeletal Pain

A Systematic Review

Carolina G. Fritsch; Paulo H. Ferreira; Joanna L. Prior; Andrew J. McLachlan; Manuela L. Ferreira


Pain. 2020;161(11):2462-2475. 

In This Article

Abstract and Introduction


Musculoskeletal pain is the greatest cause of disability worldwide. Owing to its increasing prevalence and burden, the importance of affordable treatments has been highlighted. Text message interventions are accessible, low cost, and effective in promoting healthy behaviour and managing chronic diseases. However, little is known about their role in musculoskeletal pain. This systematic review was conducted to appraise the literature on the effects of text messages (as an intervention or a component of an intervention) compared with any control on pain and function in people with musculoskeletal pain (PROSPERO: CRD42018117371). MEDLINE, EMBASE, CINAHL, Cochrane, and PEDro databases were searched from inception to April 2020. Keywords relating to musculoskeletal pain, text messages, and randomised controlled trials were combined. Methodological quality was assessed using the PEDro score. Of the 12,022 studies identified, 11 were included, with a mean PEDro score of 5.4/10 points (SD 1.3). Pooled analyses were not performed because of heterogeneity of interventions and clinical characteristics. When text messages were added to and compared with usual care, some positive effects were found only on treatment adherence. Although small and inconsistent, some positive effects were reported for pain intensity, function, care-seeking behaviour, adherence, and quality of life when text messages were added to multicomponent interventions. Moreover, text message and telephone counselling interventions had similar effects on function. Overall included studies were of limited methodological quality and heterogeneous. However, our results indicate potential benefits of text messages in the treatment of musculoskeletal pain, which need to be confirmed in future trials.


Musculoskeletal pain is a common condition worldwide[21,35] defined as "pain that arises as part of a disease process directly affecting bones, joints, muscles, or related soft tissues."[53] Its prevalence in adults may vary from 18% to 70%, with studies showing a higher prevalence for lower back and neck pain.[21,27] Low back pain, neck pain, and osteoarthritis are leading causes of years lived with disability worldwide.[17,25] Furthermore, the burden of these conditions (measured as the number of years lived with disability) has increased by 20% in the past 10 years.[17]

Research has emphasised the impact of musculoskeletal conditions because of their rising prevalence and burden and their association with the modern world trending phenomena of ageing and obesity.[4,17,14,28,39] Health costs related to musculoskeletal care are significant and estimated to represent up to 19% of all healthcare expenditure.[3] Moreover, musculoskeletal pain is also a main cause of loss of work productivity,[28,39] what further increases its personal and societal burden.[3,39]

As the burden of musculoskeletal pain is expected to grow, the importance of affordable and accessible treatments has been highlighted.[39] Although pharmacological treatments, injections, and surgical procedures have been shown to have limited use to most musculoskeletal pain conditions, advice, education, and self-management approaches have been emphasised in the literature.[16,25] Numerous technology-based interventions have been proposed to provide better access to evidence-based care,[44,54] reliable and effective self-management strategies,[10,54] and patient-centred behaviour-change interventions,[1] or to empower patients to perform shared healthcare decision-making.[29,54] These interventions may include self-management web sites,[10,54] mobile device applications,[29] telephone-based interventions,[44] and combined technology approaches.[1]

Technology-based interventions may also include provision of text messages, which may be delivered alone or as a component of a comprehensive intervention.[2,13,20] Text message–based interventions are both effective and cost-effective in improving chronic disease care, such as diabetes, cardiovascular diseases, and medication adherence.[6,13,20,47,50,56] They are also effective health promotion strategies supporting smoking cessation, weight loss, and improvements in physical activity participation.[2,13,20,22] Nevertheless, evidence of the effectiveness of text message interventions for managing musculoskeletal pain is still conflicting.

Although some studies report significant effects of text messages on pain reduction,[52,55] function,[34,52] and care-seeking behaviour[7] improvements in people living with musculoskeletal pain, other studies report no effect on the same outcomes.[5,9,32,45] Given the scalability of text message interventions, their minimal costs, low technology–related knowledge requirements, and wide utilisation,[13,20,40] it is essential to assess their use and effects on health-related outcomes in people with musculoskeletal pain. Therefore, this systematic review was conducted to appraise the literature on the effects of text message as a sole intervention or as part of an intervention and compared with any control in reducing pain and improving function in people with acute or chronic musculoskeletal pain.