Clinical care pathways for individuals with comorbid mental health disorders presenting to emergency with acute musculoskeletal pain: a narrative review

Acute musculoskeletal (MSK) pain remains a leading contributor to global disability, with little reduction in its burden over the past three decades. Despite increasing recognition of the prognostic role of psychological comorbidities such as anxiety, depression, and stress, clinical care for MSK pain continues to prioritize biomedical interventions, often at the expense of psychosocial considerations. This disconnect is particularly evident in emergency department (ED) settings, where care pathways focus on immediate physical assessment and discharge planning, with limited integration of mental health screening or support. Individuals presenting with acute MSK pain and comorbid mental health conditions may therefore experience fragmented care, increasing their risk of chronicity and suboptimal outcomes. This narrative review synthesizes current evidence on clinical care pathways for individuals presenting to EDs with acute MSK pain in the context of preexisting mental health disorders. It highlights the limitations of existing models of care, underscores the need for integrated biopsychosocial approaches, and identifies opportunities for improving patient-centered outcomes through more holistic and prognostically informed care strategies.