Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems' thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the "pain care ecosystem." We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.

中文翻译：

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加强疼痛护理生态系统，以支持公平、以人为本、高价值的肌肉骨骼疼痛护理。


改善慢性肌肉骨骼疼痛患者的健康和福祉结果需要医疗保健生态系统多个层面的集体努力。然而，必须解决整个系统对护理公平的障碍（例如，缺乏共同设计的服务;过度使用低价值护理/高价值护理使用不足;卫生人力不足;不适当的筹资模式;药物和技术的获取不公平;研究和创新不足）。在这篇叙述性综述中，利用系统的思维框架，我们综合了关于慢性肌肉骨骼疼痛研究的新见解，通过这个复杂、相互关联的系统（“疼痛护理生态系统”）的镜头进行背景化。我们研究了加强研究的系统的应用，以在整个生态系统中建设能力，以支持整个生命周期中公平的以人为本的护理和健康老龄化。这个动态生态系统的特点是三个相互关联的层次。其中心是经历慢性肌肉骨骼疼痛的人（微观水平）。该级别与卫生服务和卫生人力相关，共同设计和提供以人为本的护理（中观层面），并以当代卫生和社会护理系统（宏观层面背景）为上游进一步支持。我们提供了新出现的证据，说明我们和其他人如何努力建立生态系统的弹性以支持优质的肌肉骨骼疼痛护理：在宏观层面（例如，为肌肉骨骼政策和健康战略优先事项提供信息）;在中尺度层面（例如，跨护理环境的服务协同设计;卫生人力能力）;和下游，在微观层面（例如，以人为本的护理）。 我们概述了所使用的机制和方法，并解释了这项研究的结果、见解和影响，并得到了从澳大利亚到全球背景的真实世界例子的支持。