Background Pain is subjective unpleasant feeling of varied origin and once it is chronic (lasting more than 6 month) it could be responsible for significantly decreased quality of life. Pivotal role in pain suffering plays both peripheral and central nervous system and at these levels its intensity could be decreased by several pharmacological and non-pharmacological means. Aim Rationale of chronic management of musculoskeletal pain Materials and methods Review of contemporary bibliography in order to assess pathomechanism and causes of pain to successfully cope with the condition. Results Of utmost importance in managing pain is proper diagnosis and identification of its sources. Once this condition is met it is easier to apply diagnosis-specific treatments even including surgeries. In various clinical situations especially in chronic aged patients with multiple comorbidities personalized approach is mandatory. Armamentarium then encompasses complex actions with the use of simple counseling, medical treatment, physiotherapy, orthotics and preferably mini-invasive but also major surgical interventions. Conclusions Proper management of chronic musculoskeletal pain demands detailed analysis of complex clinical situation basing on medical history, examination and combining these data with possible imaging investigations. Often cooperation of several specialists is mandatory.