I. Introduction The World Health Organization (WHO, 1979) and the International Association for the Study of Pain (IASP, 1986) defined pain as an unpleasant sensory and emotional experience caused by tissue damage or potential tissue damage [1]. in 1995, James Campell, president of the American Pain Society, proposed pain as the “fifth major vital sign In 1995, James Campell, the president of the American Academy of Pain, introduced pain as the “fifth vital sign”. Pain is a common clinical problem for orthopaedic surgeons. If pain is not effectively controlled at the initial stage, continuous pain stimulation can cause pathological remodeling of the central nervous system, and acute pain may develop into uncontrollable chronic pain. Chronic pain is not only a painful sensory experience for patients, but also can seriously affect patients’ somatic and social functions, prolong hospitalization, increase medical costs, and prevent patients from participating in normal life and social activities. In recent years, the demand for analgesia has increased as the standard of living has improved and the awareness of pain has increased. Therefore, early analgesia is an urgent issue for physicians, based on the identification of the cause and active treatment of the primary orthopedic disease. The pain management covered by this recommendation refers only to the management of non-malignant, oncologic acute and chronic skeletal muscle pain and orthopedic perioperative pain, and does not involve the diagnosis and management of their primary diseases. This article is only an academic recommendation, and its implementation still needs to be based on the patient and the specific medical situation. II. Classification of pain According to the duration and nature of pain, it can be divided into acute pain and chronic pain. Acute pain is defined as pain that arises newly and may exist for a short period of time (less than 3 months) [2, 3], and pain that lasts for more than 3 months is considered chronic pain [4]. According to the pathological mechanism, pain can be classified as injury-receptive pain and neuropathic pain or mixed pain containing both. Injury-receptive pain is a response caused by noxious stimuli to injury receptors, and pain perception is associated with tissue damage. Pain syndromes caused by peripheral or central nervous system injury or disease are called neuropathic pain. III. Determination and assessment of pain In the process of pain diagnosis and assessment, the presence of the following conditions should be confirmed by detailed history questioning, physical examination and auxiliary examinations: (1) serious conditions requiring urgent assessment and management, such as tumors, infections, fractures and nerve injuries; (2) mental and occupational factors affecting recovery, including: attitudes toward pain, emotions, and occupational characteristics, etc. The above clinical, mental and occupational factors require simultaneous intervention and treatment. (4) The purpose and principles of pain management (1) The purpose of pain management: (1) to relieve or relieve pain; (2) to improve function; (3) to reduce the adverse effects of drugs; (4) to improve the quality of life, including the improvement of physical state and mental state. (2) Principles of pain management: five aspects should be included. (1) Pay attention to health education: pain patients are often accompanied by anxiety and nervousness, so they need to pay attention to health education and communication with them to get the cooperation of patients and achieve the ideal pain treatment effect. 2, choose a reasonable assessment: for acute pain, it is appropriate to have a simple method of pain assessment. If you need to quantify the degree of pain, you can choose a quantitative method. 3.Treat pain as early as possible: once pain becomes chronic, treatment will be more difficult. Therefore, early treatment of pain is necessary. For the treatment of postoperative pain, preemptiveanalgesia is advocated, that is, analgesic treatment is given before the occurrence of injurious stimuli. 4, advocate multi-modal analgesia: combining drugs with different mechanisms of action together to play a synergistic or additive role in analgesia, reduce the dose and adverse reactions of a single drug, and at the same time can improve the tolerance of the drug, accelerate the onset of action and prolong the analgesic time. At present, the common mode is the combination of weak opioids with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), etc., and the combination of NSAIDs and opioids or local anesthetics for nerve block. However, attention should be paid to avoid the repeated use of similar drugs. 5. Focus on individualized analgesia: There are individual differences in the response of different patients to pain and analgesic drugs, so the analgesic method should be different from person to person, and a fixed drug program should not be applied mechanically. The ultimate goal of individualized analgesia is to apply the smallest dose to achieve the best analgesic effect. V. Common methods of orthopedic pain management: (a) Non-pharmacological treatment: including patient education, physical therapy (cold compress, hot compress, acupuncture, massage, transcutaneous electrical stimulation therapy), distraction, relaxation therapy and self-behavior therapy. Non-pharmacological treatment has different therapeutic effects and precautions for different types of pain, and different treatments should be selected according to the disease and its progress. (ii) Drug treatment: Before using any kind of drugs, please refer to their instructions for use. 1. Topical topical medications: various NSAIDs emulsions, creams, patches and non-NSAIDs rubs capsaicin, etc. Topical topical drugs can effectively relieve pain caused by myofasciitis, myofasciitis, cavernositis and superficial areas of osteoarthritis, rheumatoid arthritis and other diseases. 2, systemic drugs: (1) acetaminophen [5], can inhibit the synthesis of prostaglandins in the central nervous system, producing antipyretic and analgesic effects, the daily dose does not exceed 4000mg when the adverse effects are small, an overdose can cause liver damage, mainly used for mild and moderate pain. (2) NSAIDs [6], which can be divided into traditional non-selective NSAIDs and selective COX-2 inhibitors, are used for the synergistic treatment of mild and moderate pain or severe pain. Currently, the common clinical delivery methods include oral, injectable, and anal placement. When selecting NSAIDs, it is necessary to refer to the drug instructions and assess the risk factors of NSAIDs (Table 1). If patients are at high risk for gastrointestinal adverse reactions, use non-selective NSAIDs with gastroprotective agents such as H2 receptor blockers, proton pump inhibitors, and the gastric mucosal protector misoprostol, or use selective COX-2 inhibitors. When applying NSAIDs, efficacy and safety factors should be weighed for patients at high risk for cardiovascular disease. Care should be taken to avoid the simultaneous use of two or more NSAIDs, and the elderly are advised to use NSAIDs with good hepatic, renal and gastrointestinal safety records. 3. Opioid analgesics [7]: they mainly exert analgesic effects by acting on central or peripheral opioid receptors, including codeine, tramadol, oxycodone, morphine, fentanyl and so on. The most common adverse effects of opioid analgesics include: nausea, vomiting, constipation, drowsiness and excessive sedation, respiratory depression, etc. When opioid analgesics are used for the treatment of chronic pain, the patient’s pain level should be monitored in time to adjust its dose and avoid drug dependence. 4, compound analgesics [8, 9]: composed of two or more analgesics with different mechanisms of action to achieve synergistic analgesic effects. Currently, the commonly used compound analgesics include acetaminophen plus tramadol [10]. In compound preparations, the daily dose of acetaminophen does not exceed 2000 mg. 5. Closure therapy: It is a mixture of a certain concentration and quantity of steroid hormone injection and local anesthetics injected into the lesion area, such as joints and fascia. Clinical application of steroid hormone is mainly to use its anti-inflammatory effect, improve capillary permeability, inhibit the inflammatory response and reduce the damage of pathogenic factors to the body. Commonly used corticosteroids include methylprednisolone, dexamethasone, etc. Commonly used drugs applied to local nerve endings or around the nerve trunk are lidocaine, procaine and ropivacaine, etc. 6. Adjuvant drugs: including sedatives, antidepressants, anti-anxiety drugs or muscle relaxants, etc. VI. Skeletal muscle pain management process The skeletal muscle pain management process [11-13] (Figure 1) mainly includes: (1) assessment of medical history and physical examination; (2) development of pain management plan; (3) analysis of pain, analgesic effects and adverse drug reactions; (4) modification of pain management plan if necessary; (5) health education and repeated assessment. (7) Perioperative pain management in orthopedics Perioperative pain in orthopedics includes pain caused by primary disease and surgical operation, or both. (a) The purpose of perioperative analgesia: (1) to reduce postoperative pain and improve patients’ quality of life; (2) to improve patients’ overall evaluation of the quality of surgery; (3) to enable patients to start rehabilitation training earlier; (4) to reduce postoperative complications. (B) Perioperative pain management in orthopedics: effective perioperative pain management [14-19] (Figure 2) should include preoperative, intraoperative and postoperative phases, with intraoperative analgesia being undertaken by anesthesiologists and not repeated in this recommendation. 1. Preoperative analgesia: some patients need preoperative analgesic treatment due to primary diseases, and considering the effect of drugs on bleeding (e.g. aspirin), they should switch to other drugs or stop using them. 2. Postoperative analgesia: postoperative pain intensity is high and inflammatory response is heavy; pain intensity and pain duration vary greatly among different surgeries and are related to the surgical site and type of surgery (Table 2). Oral drug analgesia can be used for those who can eat after surgery, and other drug delivery methods such as intravenous drip can be chosen for those who fast after surgery. VIII. Common pain intensity assessment methods (a) numericalratingscale (NRS) [20]: 0-10 is used to represent different degrees of pain: 0 is no pain, 1-3 is mild pain (pain does not yet interfere with sleep), 4-6 is moderate pain, 7-9 is severe pain (cannot sleep or wakes up in pain during sleep), and 10 is severe pain (Figure 3) . Patients should be asked about the severity of their pain, marked, or asked to circle a number that best represents their pain level. This method is currently more common in clinical practice. (ii) Verbaldescriptionscales (VDS) [21]: it can be divided into four levels. Level 0: no pain. Level Ⅰ (mild): pain but tolerable, normal life, no disturbance in sleep. Grade II (moderate): significant pain, intolerable, requiring sedative drugs, and disturbed sleep. Grade III (severe): pain is severe and unbearable, requiring analgesic drugs, sleep is severely disturbed, and may be accompanied by autonomic disorder or passive posture. (iii) Visual analogue scoring (visualanaloguescale, VAS) [21]: draw a long line on a paper or use a measuring tape (10 cm long), with one end representing no pain and the other end representing severe pain (Figure 4). The patient is asked to draw an “X” on the paper or ruler at the location that best reflects his or her pain level. The assessor estimates the patient’s pain level based on the location of the “X”. VAS is widely used in clinical practice, but has disadvantages: (1) it cannot be used in patients who are confused or sedated; (2) it can be used in patients with normal visual and motor function; (3) it requires estimation by the patient and the physician or nurse. Needs to be estimated by the patient and measured by the physician or nurse; (4) Difficulty in comparing the original and the reproduction to measure distance if there is a change in the length of the photographic reproduction. (iv) Facial Pain Expression Scale (FPS-R) [22, 23]: the FPS is more objective and convenient, developed on the basis of the simulation method, and uses six different expressions of the face from happy to sad and crying (Figure 5), which is simple to understand and has relatively wide applicability, and can be used for clinical reference even for young children who cannot express themselves completely and clearly in words. (v) McGill questionnaire (MPQ) [24]: the main purpose of the MPQ is to evaluate the nature of pain, and it consists of a body image indicating the location of pain, with 78 adjective words used to describe various pains, arranged in increasing intensity as sensory, affective, evaluative, and nonspecific categories. This is a multifactorial pain survey scoring method, which is designed to be more sophisticated, focusing on the nature, characteristics, intensity, concomitant status of pain and the various compound factors experienced by patients after pain treatment and their interrelationships, and is mainly used in clinical studies.