Acute Musculoskeletal Pain Research Articles

Expert opinion on heat therapy for teenagers' musculoskeletal pain management.

Among children and adolescents, up to 40% will experience musculoskeletal pain (MP), which can significantly impair functional ability, reduce quality of life, cause emotional distress, and lead to sleeping disorders for both patients and their families. The first-line treatment often involves pharmacological interventions, even though there is a lack of evidence supporting the efficacy or the safety of this approach in this specific age group. Recent guidelines recommend the implementation of preventative strategies and physical tools as the first option to minimize the use of medications. We aimed to provide an expert opinion on the use of heat therapy for MP management in young patients. This paper is the result of a virtual advisory board held by the authors in order to discuss and provide an expert opinion about the use of heat therapy in MP in children and adolescents. MP is a significant burden affecting children and adolescents. While non-steroidal anti-inflammatory drugs are currently the first-choice treatment of acute and chronic MP in children and adolescents, avoiding or reducing them in such patients is advisable, to reduce side effects and to prevent the development of chronic pain and medication overuse headaches. Heat therapy can be an additional treatment option due to its ability to promote muscle relaxation, enhance blood circulation, and modulate nociceptors with a good safety profile. MP in children and adolescents is a common condition that should be approached multidisciplinary, including information, therapeutic exercise and physical therapies like hot or cold therapies. Future studies should be conducted to evaluate the safety, efficacy and indications of each treatment in MP.

Anti-inflammatoires non stéroïdiens en prescription médicale facultative : mise au point dans la prise en charge de la douleur aiguë

Non-steroidal anti-inflammatory drugs (NSAIDs) are the second most widely used class of analgesics in France, after paracetamol. Some NSAIDs are available over the counter (OTC), without a prescription, on the advice of a pharmacist. NSAIDs have recently been the subject of safety alerts from France's Agence nationale de sécurité du médicament et des produits de santé (ANSM), highlighting a risk of worsening certain bacterial infections. This signal has not been confirmed by the European Medicines Agency (EMA) although a "risk of complications due to masking of symptoms of infection" has not been ruled out. These divergent messages can be confusing for healthcare professionals. This literature review, based on an analysis of nearly 200 scientific publications, considers the place of NSAIDs in the OTC management of migraine, tension headaches, postoperative analgesia, acute musculoskeletal and joint pain, dysmenorrhea, viral respiratory infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their toxicity. The role of the pharmacist in dispensing NSAIDs without a prescription is also addressed. NSAIDs offer rapid and effective pain management in a context of increasingly challenging access to care. Their safety profile is reassuring and generally well established but could be strengthened by conducting an ad hoc study to rule on the safety signal issued by the ANSM definitively. Pharmacists have the knowledge and tools to ensure the safe dispensing and rational use of NSAIDs, with or without a prescription. The introduction of risk minimization measures, such as decision-support tools, could enable further progress in ensuring the safe dispensing of OTC NSAIDs.

Hair cortisol sampling as a measure of physiological stress in youth with acute musculoskeletal pain

Stress physiology contributes to health outcomes. Hair cortisol concentration (HCC) is an objective measure of cumulative cortisol secretion associated with health, including pain. The aim of the current study was to describe associations between pre-injury stress physiology (as measured by HCC), acute pain characteristics and relevant demographic factors (i.e., BMI, age, sex, days since injury) in youth with an acute musculoskeletal (MSK) injury. Participants were 58 youth aged 11 to 17 with acute MSK pain. Participants completed self-report measures assessing pain intensity, pain catastrophizing, and pain interference. Hair was collected within 1 month after injury using hair cortisol collection procedures adapted from published research protocols. Correlations examining associations among HCC values and clinical/demographic factors revealed that higher HCC was associated with lower body mass index (BMI) and male sex. HCC was not associated with pain variables or age. Additional research is needed to clarify the relation between HCC and psychosocial variables to aid researchers in studying the role of pre-injury stress in acute MSK injury and pain recovery in youth.

The Efficacy of I-ALP Analgesic Gel in Acute and Subacute Musculoskeletal Pain: A Randomized Double-Blind Controlled Trial

The Efficacy of I-ALP Analgesic Gel in Acute and Subacute Musculoskeletal Pain: A Randomized Double-Blind Controlled Trial

Study to determine the efficacy and onset of Bonipar, a topical analgesic for the management of acute and chronic musculoskeletal pain

BackgroundOpioid abuse and mortality are ravaging American society, highlighting the need to find alternative effective analgesics with fewer side effects. FDA-approved topical analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat musculoskeletal pain but can cause adverse effects. Natural compounds, including essential oils, are potential therapeutic alternatives for managing musculoskeletal pain. If these compounds can provide comparable analgesia to FDA-approved products, it will increase the available options for people with pain, improving quality of life with minimal morbidity and mortality. ObjectiveThis study assesses the effectiveness and onset of action of Bonipar, a topical analgesic formulated with camphor, methyl salicylate, and oils of coconut, eucalyptus, nutmeg, and rosemary, in managing musculoskeletal pain compared to 1.5 % diclofenac solution, an FDA-approved topical non-steroidal anti-inflammatory drug. MethodsOne hundred sixty-four adult patients with localized musculoskeletal pain were randomly assigned to twice-daily applications of either Bonipar or Diclofenac for one week. The primary outcome measure was a 50 % reduction in pain after one week. Secondary outcomes included the change in pain from baseline and onset of action, defined as the first reduction in pain by 20 %. ResultsAll patients completed the initial pain assessment to determine the onset of action. One-week data was available for 74 patients treated with diclofenac and 72 patients treated with Bonipar. Data for 18 patients were incomplete. The proportion of patients achieving a 50 % reduction in pain was statistically similar between the two groups. The success rates of achieving a 50 % pain reduction with Bonipar were found to be non-inferior to those treated with diclofenac. All follow-up time points showed roughly similar results between the groups. Regression models adjusted for age and sex revealed no significant effects on pain changes. Secondary analyses demonstrated no significant differences between the groups. DiscussionThe topical analgesic Bonipar demonstrates a comparable onset of action, with efficacy non-inferior to diclofenac in the management of musculoskeletal pain, while showing fewer adverse effects compared to diclofenac. These findings highlight the potential of Bonipar as a valuable alternative for the treatment of localized pain.

Daily and Weekly Associations Among Pain Intensity, Self-Reported Activity Limitations, and Objectively Assessed Physical Activity in Youth With Acute Musculoskeletal Pain

Monitoring recovery during acute pain episodes is useful for identifying youth at risk for pain persisting. Subjective and objective measures can assess function postinjury, but associations among these different measures and pain patterns in the acute period are unknown. To fill this gap, we examined associations among self-reported activity limitations, objectively measured physical activity, and pain intensity in 176 youth (age 11–17, 46% male) seeking health care for acute musculoskeletal pain. Participants completed 7-day electronic diaries rating daily pain intensity and activity limitations (Child Activity Limitations Interview [CALI]) while concurrently wearing an Actiwatch to record physical activity. The results revealed youth reported pain on 47.8% of days with an average intensity of 33.4 (0–100). Averaged across the week, between-participant analyses showed greater activity limitations were associated with lower mean (rActive = −.204, rRoutine = −.159, P < .05) and peak activity (rActive = −.291, rRoutine = −.184, P < .05). Same-day correlations between CALI scores and physical activity measures within participants were not significant. Linear mixed-effects models revealed higher daily pain intensity was associated with greater self-reported activity limitations on Routine (β = .23, P < .001) and Active CALI-9 subscales (β = .07, P < .001). Conversely, higher daily pain was associated with higher activity on actigraphy, specifically higher mean activity (β = .46, P < .01), more activity bouts (β = .013, P < .01), more time in light activity (β = .04, P < .01), and less sedentary time (β = −.04, P < .01). Taken together, self-reported activity limitations and objective physical activity represent 2 distinct, yet related, aspects of physical functioning associated with pain. Future work should examine how physical activity and activity limitations change longitudinally and predict pain persistence. PerspectiveThis study examined daily associations between pain intensity, self-reported activity limitations, and objectively assessed physical activity in youth during the acute recovery period following a musculoskeletal injury. Self-reported activity limitations and objective physical activity represent 2 distinct, yet related, aspects of physical functioning that are associated with pain.

Impact of pharmacists’ training on the knowledge of pain and associated risks: results of the OPTYMED 2 study

The use of OTC analgesics is common worldwide, and the importance of the pharmacy teams is growing. Pharmacist-led medication implies that the pharmacy staff should have the necessary knowledge to deliver appropriate drugs, prevent an inappropriate drug consumption, and identify the patients in need of a medical advice. A randomized controlled study to assess the impact of training on pain knowledge and associated situations at risk among the French pharmacists and dispensers was performed. Participants were randomized into two groups receiving (n = 97) or not (n = 93) a training in the e-learning format. The training consisted of the 4 modules including the general knowledge of pain, headaches, acute musculoskeletal and chronic pain. The training modules were accompanied by the summary leaflets. The success rates were significantly higher in the trained group, with 35 % of participants reaching at least 70 % (primary endpoint) versus 2.3 % in the non-trained group. The results were not influenced by the size of the pharmacy. The knowledge improvement was more pronounced for the modules on the general knowledge of pain and headache management. For the questions associated to the risk situations, the success rates of at least 70 % were also significantly higher in the trained group The highest difference in success rates after the training was observed for the use of nonsteroidal antiinflammatory drugs during pregnancy and breastfeeding. Very low rates were obtained in both groups for the secondary headaches and the analgesic treatment adjustment in particular cases, such as chronic alcoholism or low weight. Results of this pilot study show that a training focused on pain could improve the overall knowledge of pain and suggest that it may contribute to a better pain identification, management and referral to physicians of patients at risk by the pharmacy staff in routine practice. The benefits of such a training should be assessed in a long-term prospective study, and the impact of a similar training in real-life practice remains to be evaluated.

An Adaptive Pragmatic Randomized Controlled Trial of Emergency Department Acupuncture for Acute Musculoskeletal Pain Management

Acute musculoskeletal pain in emergency department (ED) patients is frequently severe and challenging to treat with medications alone. The purpose of this study was to determine the feasibility, acceptability, and effectiveness of adding ED acupuncture to treat acute episodes of musculoskeletal pain in the neck, back, and extremities. In this pragmatic 2-stage adaptive open-label randomized clinical trial, Stage 1 identified whether auricular acupuncture (AA; based on the battlefield acupuncture protocol) or peripheral acupuncture (PA; needles in head, neck, and extremities only), when added to usual care was more feasible, acceptable, and efficacious in the ED. Stage 2 assessed effectiveness of the selected acupuncture intervention(s) on pain reduction compared to usual care only (UC). Licensed acupuncturists delivered AA and PA. They saw and evaluated but did not deliver acupuncture to the UC group as an attention control. All participants received UC from blinded ED providers. Primary outcome was 1-hour change in 11-point pain numeric rating scale. Stage 1 interim analysis found both acupuncture styles similar, so Stage 2 continued all 3 treatment arms. Among 236 participants randomized, demographics and baseline pain were comparable across groups. When compared to UC alone, reduction in pain was 1.6 (95% confidence interval [CI]: 0.7 to 2.6) points greater for AA+UC and 1.2 (95% CI: 0.3 to 2.1) points greater for PA+UC patients. Participants in both treatment arms reported high satisfaction with acupuncture. ED acupuncture is feasible and acceptable and can reduce acute musculoskeletal pain better than UC alone.

A PROSPECTIVE STUDY OF SAFETY AND EFFICACY OF ORAL ANALGESICS IN THE MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN

Objective: Musculoskeletal pain is a significant health problem in adolescents and challenging condition for clinicians and physicians. Acute musculoskeletal pain is sudden and severe which lasts less than 12 w. This study was aimed to assess the efficacy safety of oral analgesics in the management of the condition. Methods: A Prospective study on oral analgesics prescribed routinely for this pain was conducted among 100 patients who attended OPD, at Area Hospital, Dharmavaram. 25 patients were included in each group; group a were given tramadol 100 mgOD, group B-paracetmol 500 mgBD, Group C-ibuprofen 200 mgBD and group D-dicolfenac 50 mgBD. The severity of pain assessed by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). The data was analysed by using SPSS-21version. Results: Number of subjects included in the analysis 100 who were divided equally into 4 groups. The improvement in pain relief as follows-Group a given tramadol 100 mg showed pain relief of 80%VAS and 84%VRS. Group b given paracetmol 500 mgBD-40% by VAS and VRS. Group c given ibuprofen 200 mgBD showed 60% by VAS and 68% by VRS. GROUP D given diclofenac 50 mgBD showed better improvement of pain relief i. e 88% by VAS and 96% by VRS, yet the p-value is 0.001, showing difference statistically significant. Conclusion: Among all 4 groups, Tramadol and Diclofenac showed better response (80% and 84%;88 and 96% respectively). Diclofenac is non-opioid. Hence, considering safety and improvement in pain relief in acute musculoskeletal Pain, Oral Diclofenac is preferred analgesic of choice over oral tramadol, an opioid with an adverse drug reaction profile that includes rising BP, causing seizure and addiction liability.

A sequential, multiple-assignment, randomized trial of analgesic strategies for acute musculoskeletal Pain

BackgroundMost methodologically rigorous, ED-based, comparative effectiveness analgesic studies completed in the last two decades failed to find a clinically important difference between the comparators. We believe that many of these comparative effectiveness studies were biased towards the null hypothesis because some ED patients with intense pain will respond to relatively mild interventions. We hypothesized that including a run-in period would alter the results of an acute pain RCT. MethodsWe conducted a sequential, multiple-assignment, randomized study. Adults with acute moderate/severe musculoskeletal pain were randomized (3:1 ratio) to run-in period or no run-in. We administered 650 mg acetaminophen to run-in participants. Those run-in patients who reported insufficient relief one-hour later were randomized (1:1 ratio) to ibuprofen 800mg PO or ketorolac 20mg PO as were all participants randomized to no run-in. The primary outcome was achieving a clinically important improvement, defined as improvement ≥1.3 on a 0–10 scale. We built a logistic regression model including run-in/no run-in, ketorolac/ibuprofen, age and sex. ResultsOf 307 participants who received acetaminophen, 100 (32.6%) reported inadequate relief and were randomized to an NSAID. Of the 100 patients randomized to no run-in, 84/100 (84%) achieved the primary outcome versus 246/287 (86%) run-in participants (95% CI for difference = 2%:−7,10%). Among run-in participants who received an NSAID, 82/99(83%) achieved the primary outcome versus 84/100(84%) no run-in participants (p = 0.82). Among all ibuprofen participants, 44/49(90%) randomized to run-in and 42/50(84%) randomized to no run-in achieved the primary outcome. Among all ketorolac participants, 38/50(76%) randomized to run-in and 42/50 (84%) randomized to no run-in achieved the primary outcome. We observed the following results in a multivariable analysis: OR for ketorolac versus ibuprofen:0.60 (95% CI: 0.28, 1.28); OR for run-in versus no run-in:0.91(95% CI: 0.43, 1.93). ConclusionsAmong patients with acute musculoskeletal pain, using an acetaminophen first strategy did not alter pain outcomes.

Topical Diclofenac Versus Oral Ibuprofen Versus Diclofenac + Ibuprofen for Emergency Department Patients With Acute Low Back Pain: A Randomized Study

IntroductionTopical non-steroidal anti-inflammatory drugs (NSAIDs) are useful for a variety of musculoskeletal injuries. It is not known whether topical NSAIDs should be used for patients presenting with acute non-radicular musculoskeletal low back pain (LBP). MethodsWe conducted a randomized, placebo-controlled double-blind study in which ED patients 18-69 years with acute, non-traumatic, non-radicular, musculoskeletal LBP were randomized at the time of discharge to treatment with oral ibuprofen 400mg orally + placebo topical gel, 1% diclofenac topical gel + oral placebo, or ibuprofen 400mg + 1% diclofenac topical gel. We measured outcomes using the Roland Morris Disability Questionnaire (RMDQ), a 24-item yes/no instrument about the impact of back pain on a respondent’s daily activities. The primary outcome was change in RMDQ between ED discharge and two days later. Medication related adverse events were elicited by asking whether the study medications caused any new symptoms. Results3281 patients were screened for participation and 198 were randomized. Overall, 36% of the population were women, the mean age was 40 years (SD 13), and the median RMDQ score at baseline was 18 (25th, 75th percentile: 13, 22) indicating substantial low back related functional impairment. 183 (92%) participants provided primary outcome data. By two days after the ED visit, the ibuprofen + placebo group had improved by 10.1(95%CI 7.5 to 12.7), the diclofenac gel + placebo group by 6.4(95%CI 4.0 to 8.8), and the ibuprofen + diclofenac gel by 8.7(95%CI 6.3 to 11.1). The 95%CI for between group differences were as follows-- ibuprofen versus diclofenac: 3.7 (0.2, 7.2); ibuprofen versus both medications 1.4 (-2.1, 4.9); diclofenac versus both medications -2.3 (-5.7, 1.0). Medication related adverse events were reported by 3/60 (5%) ibuprofen patients, 1/63 (2%) diclofenac patients, and 4/64 (6%) patients who got both. ConclusionsAmong patients with non-traumatic, non-radicular acute musculoskeletal low back pain discharged from an ED, topical diclofenac was probably less efficacious than oral ibuprofen. It demonstrated no additive benefit when co-administered with oral ibuprofen.

Effects of foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain: a systematic review of randomized trials

ObjectiveTo analyze the effects of using foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain.MethodsThis systematic review was registered in the National Institute for Health Research’s prospective online registry of systematic reviews (PROSPERO) under CRD42023456841. The databases Pubmed, Medline (via Ovid), Embase, BVS, and PEDro (Physiotherapy Evidence Database) were consulted to carry out this systematic review. Notably, the records of clinical trials characterized as eligible were manually searched. The search terms were: (foam rolling OR foam rolling vibration) AND (acute musculoskeletal pain) AND (chronic musculoskeletal pain). The search was performed until August 22, 2023. For the analysis of the methodological quality, the PEDro scale was used for each of the manuscripts included in the systematic review. Due to the heterogeneity in the studies included in this systematic review, performing a meta-analysis of the analyzed variables was impossible.ResultsOnly six manuscripts were eligible for data analysis. The type of FR used was non-vibrational, being applied by a therapist in only one of the manuscripts. With an application time ranging from at least 45 s to 15 min, the non-vibrational FR was applied within a day up to six weeks. Using the PEDro scale, scores were assigned that varied between 4 and 8 points, with an average of 6 ± 1.29 points. Only two randomized clinical trials found a significant benefit in pain intensity of adding FR associated with a therapeutic exercise protocol in individuals with patellofemoral pain syndrome and chronic neck pain.ConclusionThe results of this systematic review do not elucidate or reinforce the clinical use of FR in pain intensity in individuals with chronic and acute musculoskeletal pain.

The efficacy and tolerability of tolperisone hydrochloride various regimens in the treatment of patients with acute musculoskeletal low back pain

To analyze the effectiveness and tolerability of various regimens for the use of tolperisone hydrochloride (TH) in the treatment of patients with acute nonspecific lower back pain (ALBP). 90 patients with ALBP (54.3 [48.7; 61.3] years) were divided into 2 groups: group 1 (n=45) received basic therapy - NSAIDs, B vitamins and TH sustained release (450 mg/day per os), group 2 (n=45) used basic treatment and TH 2 ml intramuscularly 2 times a day for 5 days with a transition to a TH sustained release 450 mg/day per os. The total duration of the study was 30 days. We analyzed the visual analogue pain scale (VAS-B), the results of the modified modified Schober test (MMST), the medication adherence scale (Drug Attitude Inventory - DAI-10), the Epworth daytime sleepiness scale (ESS), functional activity associated with low back pain (Roland-Maurice questionnaire, RM), duration of TH intake (days), frequency and characteristics of adverse events (AE). At the screening visit, all patients were additionally divided depending on the intensity of pain according to VAS-B («mild», «moderate», «severe»). There were no significant differences on the VAS-B scale between groups 1 and 2 in patients with mild pain; there was significantly more complete pain control in group 2 with moderate pain after 14 and 30 days, (p=0.0013, 14 days; p=0.0021, 30 days); among patients with severe pain, the best result after 30 days was observed in group 2 (p=0.0016). In all patients the range of motion in the lumbosacral spine (MSST) significantly increased and functional activity (RM) improved compared to the initial state: more significant in group 2 with moderate pain after 14 and 30 days and with severe pain after 30 days. There was a high adherence to therapy (DAI-10), more pronounced in the first 14 days in patients of group 1. Excessive daytime sleepiness (ESS) was not observed. For moderate pain, patients in group 2 used TH for a significantly shorter period of time (16.4±1.6 days) compared to patients in group 1 (19.6±2.2 days, p=0.0022). AE were mild and did not serve as a reason to refuse therapy. A protocol for prescribing TH was proposed, based on stratification of patients according to VAS-B.The use of TH for ALBP is effective and safe. The proposed protocol for stratifying patients according to VAS-B level allows identifying the patients with step-by-step scheme of prescribing the drug for a period of 14 to 30 days.

Regional Anesthesia for Acute Pain Treatment in Pre-Hospital and In-Hospital Emergency Medicine.

More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting. Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed. 43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids. Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.

Changes in Desk-Based Workers' Sitting, Standing, and Stepping Time: Short- and Longer-Term Effects on Musculoskeletal Pain.

Sitting at work can be associated with musculoskeletal pain, but the effect of reductions in sitting is not well understood. We examined relationships with musculoskeletal pain of changes in sitting, standing, stepping, and short and long bouts of these behaviors. Analyses pooled data from 224 desk workers (68.4% women; mean ± SD age = 45.5 ± 9.4 yr; body mass index = 28.1 ± 6.1 kg⋅m -2 ) in intervention trial. Device-assessed (activPAL3) sitting, standing, and stepping time and multisite musculoskeletal pain (Nordic Questionnaire; 12 body areas) were assessed at baseline, 3 months, and 12 months. Compositional data analyses in linear mixed-effects regressions examined relationships within 16 waking hours of the behaviors and their short and long bouts, with changes from baseline in acute and chronic multisite musculoskeletal pain at 3 and 12 months. Analyses were adjusted for initial group randomization and relevant covariates. At 3 months, increased standing relative to changes in other compositions was significantly associated with increased multisite musculoskeletal pain (acute: β = 1.54, 95% confidence interval [CI] = 0.10 to 2.98; chronic: β = 1.49, 95% CI = 0.12 to 2.83). By contrast, increased stepping relative to changes in other compositions was significantly associated with reduced multisite musculoskeletal pain (acute: β = -1.49, 95% CI = -2.97 to -0.02; chronic: β = -1.87, 95% CI = -3.75 to -0.01). Neither sitting reduction relative to changes in other compositions nor changes in short bouts relative to long bouts of the behaviors were significantly associated with multisite musculoskeletal pain changes. At 12 months, there were no significant associations for any of the compositional changes. In the short term, while increasing standing with reduced sitting time can be unfavorable, concurrently increasing stepping could potentially reduce musculoskeletal pain. In the longer term, musculoskeletal pain may not be increased by moderate reductions in sitting time through spending more time standing or stepping.

Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta-analysis.

Opioids are often prescribed for acute pain to patients discharged from the emergency department (ED), but there is a paucity of data on their short-term use. The purpose of this study was to synthesize the evidence regarding the efficacy of prescribed opioids compared to nonopioid analgesics for acute pain relief in ED-discharged patients. MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and gray literature databases were searched from inception to January 2023. Two independent reviewers selected randomized controlled trials investigating the efficacy of prescribed opioids for ED-discharged patients, extracted data, and assessed risk of bias. Authors were contacted for missing data and to identify additional studies. The primary outcome was the difference in pain intensity scores or pain relief. All meta-analyses used a random-effect model and a sensitivity analysis compared patients treated with codeine versus those treated with other opioids. From 5419 initially screened citations, 46 full texts were evaluated and six studies enrolling 1161 patients were included. Risk of bias was low for five studies. There was no statistically significant difference in pain intensity scores or pain relief between opioids versus nonopioid analgesics (standardized mean difference [SMD] 0.12; 95% confidence interval [CI] -0.10 to 0.34). Contrary to children, adult patients treated with opioid had better pain relief (SMD 0.28, 95% CI 0.13-0.42) compared to nonopioids. In another sensitivity analysis excluding studies using codeine, opioids were more effective than nonopioids (SMD 0.30, 95% CI 0.15-0.45). However, there were more adverse events associated with opioids (odds ratio 2.64, 95% CI 2.04-3.42). For ED-discharged patients with acute musculoskeletal pain, opioids do not seem to be more effective than nonopioid analgesics. However, this absence of efficacy seems to be driven by codeine, as opioids other than codeine are more effective than nonopioids (mostly NSAIDs). Further prospective studies on the efficacy of short-term opioid use after ED discharge (excluding codeine), measuring patient-centered outcomes, adverse events, and potential misuse, are needed.

A comparative study of the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain

Background: Thiocolchicoside and chlorzoxazone are commonly used muscle relaxants for the management of acute musculoskeletal pain. However, there is limited evidence comparing their efficacy and safety. Aims and Objectives: The aim of the study was to compare the efficacy and safety of thiocolchicoside and chlorzoxazone in patients with acute musculoskeletal pain. Materials and Methods: This was a randomized, open-label, parallel-group study conducted in a tertiary care hospital. A total of 50 patients with acute musculoskeletal pain were randomized to receive either thiocolchicoside (8 mg) or chlorzoxazone (500 mg) thrice daily for 7 days. The primary outcome measure was the change in pain intensity from baseline to Day 7, assessed using a visual analog scale (VAS). The secondary outcome measures were the percentage reduction in pain intensity and the incidence of adverse events. Results: The baseline characteristics of the patients were similar in both groups. The mean baseline pain intensity was 7.2±1.3 in the thiocolchicoside group and 7.1±1.2 in the chlorzoxazone group. After 7 days of treatment, both drugs significantly reduced pain intensity from baseline. The mean pain intensity at Day 7 was 2.9±1.1 in the thiocolchicoside group and 3.1±1.2 in the chlorzoxazone group. The percentage reduction in pain intensity was 59.7%±12.3% in the thiocolchicoside group and 56.3%±11.5% in the chlorzoxazone group. However, there was no statistically significant difference between the groups in terms of pain intensity reduction (P=0.453). Conclusion: The results of this study suggest that thiocolchicoside and chlorzoxazone are equally effective and safe in the management of acute musculoskeletal pain. The choice of drug may depend on the patient’s individual characteristics and risk factors.

Treatment of acute and chronic cervical musculoskeletal pain

Pain in the cervical spine is a widespread condition that significantly disrupts the quality of life, often leads to disability and requires significant economic costs. The most common type of neck pain is nonspecific (vertebrogenic cervicalgia). The most frequent (in 36–67% of cases) anatomical source of nonspecific neck pain is considered to be the lesion of the intervertebral facet joints. Tests to determine the anatomical sources of nonspecific pain are unreliable, in addition, their detection does not significantly affect treatment. Degenerative changes of the spine are often detected during neuroimaging, depend on age, but do not correlate with clinical symptoms and severity of symptoms. In the absence of red flags of anxiety and negative results of neurological examination, neuroimaging or laboratory methods of research are not required. An assessment of prognostic factors is important. Factors contributing to chronization include: female sex, old age, high intensity of pain at the onset of the disease, the presence of psychosocial problems. Modern classifications, the basics of diagnosis, treatment and prevention of nonspecific neck pain are given. Modern effective methods of treatment are physical therapy, manual therapy and psychological programs, a multimodal approach to treatment is optimal. There is a very low level of evidence for electrotherapy, traction, laser therapy, acupuncture, dry needle treatment, thermal or cold procedures. The use of drug therapy is recommended, both separately and in combination with other methods of treatment. The most effective painkillers for neck pain are non-opioid analgesics – NSAIDs and paracetamol. The use of cervical orthosis is not recommended. Clinical cases of patients with acute and chronic nonspecific neck pain are described. The effectiveness of an integrated approach to the management of this category of patients, in accordance with modern recommendations, is shown. The treatment included drug and non-drug methods (therapeutic gymnastics, educational conversation). Dexketoprofen was used as pharmacotherapy according to a step-by-step regimen.

Therapy for Musculoskeletal Pain

Therapy for Musculoskeletal Pain

Physiotherapists’ clinical reasoning in examination of clients with low back pain in direct access practice: a theory-driven qualitative content analysis

Aim The aim of this study was to gain deeper understanding of physiotherapists’ clinical reasoning in examination of clients with low back pain (LBP) in direct access (DA) practice. Method Data were collected through individual semi-structured thematic interviews of ten physiotherapists who described their clinical reasoning in one of their LBP clients in direct access practice. The interviews were recorded and transcribed verbatim and then examined using a theory-driven qualitative content analysis. Four clinical reasoning models, hypothetico-deductive, pattern recognition, narrative and systematic, were used as theoretical frameworks to analyse the descriptions of physiotherapists’ clinical reasoning in examination. Results In this study clinical reasoning in examination manifested as a process where physiotherapist proceeds from interview to clinical assessment and decision-making, simultaneously taking into consideration the DA setting and the specific role of the physiotherapist. As described by the physiotherapists working in DA practice clinical reasoning in examination presented by extracting facts from the interview in relation to symptoms or certain diagnosis, identifying and excluding red flags and identifying the factors that were important to consider in acute musculoskeletal pain in relation to individual client’s problem. Physiotherapists described having improved differential diagnostic skills, wider range of physical assessment techniques and more precise assessment. Based on the data, the physiotherapists presented to use either the hypothetico–deductive or the systematic clinical reasoning model when examining an LBP client in DA practice. Conclusions Clinical reasoning in examination with LBP clients in direct access practice started with anamnesis and proceeded by using either the hypothetico–deductive or the systematic clinical reasoning model.