The relevance of loneliness on how we think about MSK rehabilitation

In this month’s Clinical Insight, we discuss the relevance of social isolation and loneliness in individuals with persistent musculoskeletal (MSK) pain.

Social isolation is linked to a reduction in an individual’s social network. This may occur as a result of personal choice, such as withdrawal, relocation, or natural diminishment of social contacts, which is more common among older adults. Loneliness can be described as the psychological consequence of social isolation and is expressed as dissatisfaction with one’s social network and social interactions.

Links Between Musculoskeletal Pain, Loneliness, and Function

Loneliness has the potential to impact a range of physical and mental health outcomes, including cardiovascular disease and cognitive decline. Additionally, due to reduced physical activity, it may eventually influence the musculoskeletal system. This relationship was investigated by Smith et al. (2019), who found that musculoskeletal pain can lead to loneliness through inactivity. However, decreased social isolation was also noted among individuals with MSK pain, possibly due to increased support from family members.

Rap-Pylkkö et al. (2016) previously reported that older adults with persistent pain demonstrated poorer function, felt sadder and lonelier, and experienced greater fatigue than those without long-term symptoms.

Nicholson et al. (2020), in a cohort study of older adults, found that 84% reported MSK pain. The majority were women, lived alone, resided in socially deprived areas, and had three or more health conditions compared with those without chronic symptoms. Participants reporting MSK pain were more likely to experience loneliness or lack of social support, which is in slight contrast to the findings above. Qualitative studies have concluded that withdrawal and social isolation are common features of long-term MSK pain and are linked to its effects on relationships and the enjoyment of hobbies and pastimes.

Further research has suggested that distress related to pain sensations may have a greater impact than loneliness itself. However, loneliness remains an important moderator of these feelings and may therefore play a valuable role in supporting psychological balance (Pone et al., 2025).

Supporting Rehabilitation Through Social Connection

What does this mean for patients and clinicians? In rehabilitation, particularly within physiotherapy, patients often focus on “exercise,” while pastimes, hobbies, social groups, and interactions may not be viewed as part of the rehabilitation process. However, these factors should be considered of real value. Strengthening social connections and building resilience against the social isolation associated with pain may improve the psychological experience of loneliness and contribute to better outcomes.

Patients should be understood in terms of what brings them joy, the social connections they maintain, and whether MSK pain has negatively affected these experiences. By doing so, MSK practitioners can design rehabilitation programs that emphasise social connection and meaningful activities, rather than relying solely on physical activity and exercise. Although exercise provides physical benefits, without the right approach it may not deliver the same psychological improvements that social engagement and shared activities can offer.

References

• Ponce, H., Cordero, R., Ring, D., Sayegh, G., Azarpey, A. and Jayakumar, P., 2025. Are Levels of Loneliness Associated With Levels of Comfort and Capability in Musculoskeletal Illness?. Clinical Orthopaedics and Related Research®, 483(4), pp.635-642.
• Rapo-Pylkkö S, Haanpää M and Liira H. 2016 Chronic pain among community-dwelling elderly: a population-based clinical study. Scand J Prim Health Care; 34: 159– 164.
• Smith, T.O., Dainty, J.R., Williamson, E. and Martin, K.R., 2019. Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing. British Journal of Pain, 13(2), pp.82-90.