Background Diagnostic imaging for musculoskeletal pain continues to rise despite limited diagnostic value and clear guidelines. Patients often perceive imaging as reassuring and essential for understanding their condition, yet the psychosocial and contextual dimensions underpinning this desire remain poorly defined and inconsistently considered. Objectives To identify and map the psychosocial and contextual dimensions influencing patients’ desire for diagnostic imaging in adult musculoskeletal pain. Method A scoping review following Joanna Briggs Institute methodology searched five databases. Two reviewers independently screened and extracted data. Extracted dimensions were analysed with consideration of the method and timing of their capture, then synthesised thematically to develop a conceptual framework. Results 27 studies met inclusion criteria, yielding 35 discrete psychosocial and contextual dimensions organised into 10 superordinate themes, most frequently relating to pain's structural basis, management, ruling out serious pathology, and pain validation. Assessment of patients' desire for imaging was inconsistent across a heterogeneous evidence base, with only one prospective study and no imaging-naïve cohorts. Evidence of direct modification of patients' desire for imaging was limited; however, related psychosocial dimensions showed potential for change through clinician communication and patient education. Conclusions Patients' desire for diagnostic imaging in musculoskeletal pain reflects interrelated cognitive and emotional needs rooted in the inherent uncertainty of non-specific pain. The field has accumulated substantial knowledge of patients' wider imaging beliefs, but desire for imaging remains inconsistently conceptualised and poorly measured. The proposed Diagnostic Imaging Desire Framework offers a foundation for instrument development and interventions to support shared decision-making and reduce unnecessary imaging.
