Chronic Musculoskeletal Pain Conditions Research Articles

Effect of Lower Trapezius, Middle Trapezius and Serratus Anterior Muscles Strengthening on Pain, Muscle Strength and Functional Status in individuals with Non-Specific Chronic Neck Pain

Background: Chronic non-specific neck pain is the most common chronic musculoskeletal paincondition, causing significant pain, disability, and lost productivity. On-specific neck pain is not just a clinical problem, it can develop into a complex disorder where physical, psychological, social compensation and other possible forces interact to cause and lead to maintained disability. Neck pain is present with weakness and muscular imbalance. It has a close relationship between muscle prone to tightness and those prone to inhibition. In the case of neck pain, there is tightness of upper trapezius (UT) muscle leading to middle trapezius (MT), lower trapezius (LT) and serratus anterior (SA) muscles weakness. There is evidence that scapulothoracic muscles weakness may also be associated with neck pain. Individuals with neck pain were having significantly weaker Lower Trapezius, Middle Trapezius and Serratus Anterior muscles strength than asymptomatic individuals.Context and Purpose: There is emerging evidence that scapulothoracic muscles weakness often is associated with neck pain and it has a close relationship between muscle prone to tightness and those prone to inhibition. In the case of neck pain, prolonged tightness of upper trapezius muscle can lead to middle trapezius, lowertrapezius, and serratus anterior muscles weakness. The purpose of the study is to find out the effect of LT, MT and SAmuscles strengthening along with the conventional treatment on pain, muscle strength and functional status in non-specifi cchronic neck pain. Results: There was significant effect on LT, MTand SA muscles strengthening in reducing pain, improving strength and functional status in individuals with non-specific chronic neck pain. Conclusion: Strengthening exercises to LT, MT and SA muscles along withconventional therapy is effective in reducing pain, improving muscle strength and functional status inindividuals with nonspecific chronic neck pain.

Emotional and Attentional Bias in Fibromyalgia: A Pilot ERP Study of the Dot-Probe Task.

IntroductionThe present research investigates the neural correlates of attentional bias in fibromyalgia (FM) with a dot-probe task performed during an electroencephalogram (EEG) recording.MethodsFor this purpose, 30 female participants were recruited, divided into two groups: a group of patients with FM (FM, n = 15, Mage = 51.87) and a healthy control group (HC) (HC, n = 15, Mage = 46.13).ResultsThe results did not show behavioral differences between groups, but the EEG results showed that healthy controls had larger P300 amplitudes than patients with FM. Regarding late positive potentials (LPP), we found that patients with FM had larger amplitudes than healthy controls in a later time window.ConclusionIn summary, while the P300 results suggest that patients allocate less attentional resources to the task, the increased amplitudes of their LPP suggest augmented emotional processing of the target stimuli. Altogether, our results seem to support the thesis of generalized attentional deficits in FM.

215 Emergency Department Acupuncture for Acute Musculoskeletal Pain Management

Musculoskeletal pain, which accounts for 5-10% of emergency department (ED) visits, remains challenging to treat effectively. This study aims to determine the feasibility, acceptability, and effectiveness of ED acupuncture for treating acute musculoskeletal pain. This pragmatic randomized clinical trial used a three-arm two-stage adaptive design to: 1) determine the more effective ED-based acupuncture approach, and 2) measure the effectiveness of the selected acupuncture approach when added to usual care compared to usual care alone on pain reduction in the ED. Two acupuncture approaches tailored for rapid performance in the ED were auricular acupuncture (AA: ears only) and peripheral acupuncture (PA: head, neck and extremities only). Adult (age >18 years) ED patients were recruited if they had a new onset (≤7 days) of musculoskeletal pain (ie, pain in the neck, back, arms and/or legs) or an acute exacerbation of chronic musculoskeletal pain condition. Patients were screened, consented, and randomized 1:1:1 in the early part of the study and 2:2:1 after planned interim analysis to either AA, PA or no acupuncture (NA) during their ED visit. Patients randomized to AA or PA received their acupuncture treatment while in the ED by a formally trained and licensed acupuncturist. All arms received usual care, including medications, at the discretion of their ED provider who remained blinded to study arm assignment. The primary outcome was the change in numeric rating scale (NRS) pain score from ED baseline to 1 hour after treatment initiation, with a change of 1.3 determined a priori to be clinically significant. Secondary outcomes included patient satisfaction with acupuncture on a 5-point Likert scale (1-“not at all” to 5-“very much”). Descriptive statistics were reported as mean ± standard deviation. A total of 224 patients were enrolled and randomized between February 2020 and April 2021. Demographics of participants were mean age 45.9 ± 16.4 (range 19-85 years), 56.2% female, 54.5% black or African American, 32.1% White or Caucasian, and 7.6% Hispanic. Planned interim analysis for the adaptive design did not identify a significant difference between AA and PA arms, resulting in all three arms being continued for the duration of the study. All three arms had similar ED baseline pain scores (AA 7.1 ± 2.3, PA 7.1 ± 2.4, NA 6.9 ± 2.3). Greater pain reductions at 1 hour follow-up in the ED were observed with both AA (2.1 ± 2.8) and PA (1.6 ± 2.0) than with NA (0.3 ±2.0). High patient satisfaction was reported for both AA (4.30 ± 1.00) and PA (4.48 ± 0.82). Our two acupuncture approaches when added to usual care were feasible for the fast-paced ED setting, produced significantly greater pain reductions compared to usual care alone, and were acceptable to ED patients with acute musculoskeletal pain.

Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis.

Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [-0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P<0.001, I2=92.43%, studies: n=42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P<0.001, I2=76.52%, studies: n=33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.

Effects of Middle Trapezius, Lower Trapezius, and Serratus Anterior Strengthening on Pain and Functional Status in Lateral Epicondylalgia

Background: Lateral Epicondylalgia (LE) is described as a tendinopathy at the common extensor origin at the lateral epicondyle of the humerus 1. Approximately 40% of people will experience LE at some point in their life. Recent studies highlighted the importance of assessing Middle Trapezius (MT), Lower Trapezius (LT) and Serratus Anterior (SA) muscle strength and also the importance of strength training in LE. CONTEXT AND PURPOSE: LE is the most common chronic musculoskeletal pain condition, causing significant pain, disability and lost productivity. Various studies focusing on scapular muscle strength and endurance give some indication that scapular muscle may need to be screened and treated. RESULT: There was significant effect on middle trapezius, lower trapezius and serratus anterior strengthening on reducing pain and improving functional status in patients with LE. CONCLUSION: The study primarily tried to analyze the effects of strengthening exercises to MT, LT, and SA along with conventional therapy on pain and functional status in LE patients. And this study reveals that addition of strengthening exercises to MT, LT and SA to the regimen enhances faster recovery in patients with LE. KEY WORDS: Lateral Epicondylalgia, Middle Trapezius, Lower Trapezius, Serratus Anterior.

Management of Chronic Musculoskeletal Pain Through a Biopsychosocial Lens.

Chronic musculoskeletal pain continues to constitute a rising cost and burden on individuals and society on a global level, thus driving the demand for improved management strategies. The biopsychosocial model has long been a recommended approach to help manage chronic pain, with its consideration of the person and his or her experiences, psychosocial context, and societal considerations. However, the biomedical model continues to be the basis of athletic therapy and athletic training programs and therefore clinical practice. For more than 30 years, psychosocial factors have been identified in the literature as outcome predictors relating to chronic pain, including (but not limited to) catastrophizing, fear avoidance, and self-efficacy. Physical assessment strategies such as validated outcome measures can be used by the athletic therapist and athletic trainer to determine the presence or severity (or both) of nonbiogenic pain. Knowledge of these predictors and strategies allows the athletic therapist and athletic trainer to frame the use of exercise (eg, graded exposure), manual therapy, and therapeutic modalities in the appropriate way to improve clinical outcomes. Through changes in educational curricula content, such as those recommended by the International Association for the Study of Pain, athletic therapists and athletic trainers can develop profession-specific knowledge and skills that will enhance their clinical practice and enable them to better assist those living with chronic musculoskeletal pain conditions.

Care for chronic musculoskeletal pain varies across age

An increasing prevalence of chronic musculoskeletal (MSK) pain conditions has been documented for children, adolescents, and young adults. Despite this increase, there has been scarce literature examining treatment modalities for MSK and, in particular, differences in treatments across ages. In this volume of The Journal, Feldman and Nahin reported treatment trends for children and young adults who had received care for MSK. The results indicated that non-opioid medication use was the most commonly prescribed intervention, relative to other interventions such as counseling and physical therapy, and that the primary mode of therapy changed across age groups. One of the more interesting features of this report was the finding that the prescription of opioids increased in the older cohort (ages 18 to 24) and was similar to opioid prescription rates among adults. This finding is noteworthy given that medication-based treatments for MSK have not been subject to clinical trials, and the long-term use of pain medication is problematic. For pediatricians, the results of this study are informative for several reasons. First, the topic of opioid use is a relevant topic of study in healthcare, and a reliance on opioids to manage pain earlier in life could lead to increased dependency in adulthood. Second, these data reveal the type of MSK referred at given age ranges, which sheds some light on relative symptom presentation that has been lacking in the literature. Third, the authors highlight the need for multidisciplinary care to address the biopsychosocial impact of MSK. Finally, these results support the need for additional research on the identification and management of MSK in the pediatric population. Article page 212 ▸ National Estimates of Chronic Musculoskeletal Pain and Its Treatment in Children, Adolescents, and Young Adults in the United States: Data From the 2007-2015 National Ambulatory Medical Care SurveyThe Journal of PediatricsVol. 233PreviewTo portray physician office visits by young Americans with chronic musculoskeletal pain; to describe clinical management in this group; and to explore factors associated with prescribed treatments. Full-Text PDF

Specialty Differences in Initial Evaluation of Patients With Non-Acute Musculoskeletal Pain.

To explore medical diagnostic testing of new cases of musculoskeletal (MSK) conditions associated with chronic pain. We analyzed nationally representative cross-sectional data of people having visits with a new likely chronic MSK pain condition. We documented depression screening and prescribing of diagnostic imaging and blood tests and explored associations between patient and provider factors for each. Over the 9 years of the survey, there were 11,994 initial visits for chronic MSK pain, an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions for depression screening, prescribed imaging, and blood tests were 1.79%, 36.34%, and 9.70%, respectively. People on any public health insurance had twice the increased relative odds to be screened for depression. Orthopedists had 3 times increased relative odds to prescribe imaging compared with family physicians; oncologists had 4 times increased relative odds to prescribe blood tests. Survey year was significantly associated with depression screening and ordering any type of imaging. Observed rates of depression screening and nonindicated imaging for patients with chronic MSK pain have fluctuated over time. The impact of these fluctuations on clinical practice is as yet unknown. The type of nonrecommended actions varied by specialty of physician.

Pain reduction induced by tapentadol in patients with musculoskeletal chronic pain fosters better sleep quality.

BackgroundPoor sleep may predict the increase and intensification of pain over time with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. However, the impact of different analgesic therapies on quality of life, functional recovery and sleep has been poorly assessed to date, whereas these evaluations may greatly help clinicians in the selection of treatment when dealing with patients with chronic pain (CP).MethodsTo explore whether tapentadol-induced pain relief may drive improved sleep quality, we carried out a pooled analysis of real-world data collected from 487 patients with CP (mean age, 68.3 years; 57.7% women) suffering from a wide range of chronic musculoskeletal pain conditions and treated with tapentadol.ResultsFollowing tapentadol treatment, patients experienced an 80% reduction in the frequency of very disturbed sleep as well as a 50% reduction in the predominant sleep complaint reported by patients with CP – that is, nocturnal awakenings. A significantly greater proportion of patients reported good/restful sleep at the end of the study period compared to baseline (72.4% versus 25.3%; p<0.01). This benefit was observed regardless of the clinical setting, treatment duration, posology or patient age and was associated with a higher proportion of patients reporting an improved global health status and good tolerability.ConclusionThe reduction in pain intensity provided by tapentadol fosters sleep quality and favours a better quality of life. Therefore, our findings provide the rationale for addressing sleep quality as a relevant outcome, complementary to pain relief in CP management.

Daily associations between sleep and pain in patients with chronic musculoskeletal pain.

Patients with chronic pain commonly report sleep problems, and the evidence for a relationship between sleep disturbance and pain seems robust. The day-to-day associations between these constructs are less well studied, particularly with objective sleep measures such as actigraphy. Moreover, the concurrent presence of negative affective symptoms, as well as seasonality effects at extreme latitudes may complicate it further. Here, we studied 56 patients with chronic primary musculoskeletal pain conditions, contributing data in two separate 7-day data-collection periods during the summer and winter, respectively. The effect of self-reported sleep quality, and actigraphy measured sleep duration, efficiency and timing on next-day pain, as well as the effect of pain on the same sleep indices were estimated by generalised linear mixed regression models. The models were additionally adjusted for age, sex, education, data collection period, weekend, season and mental distress, with the latter two also specified as moderators. We observed a significant effect of pain as a predictor of next-night sleep quality (p=.003) and marginally of next-night sleep duration (p=.079). Conversely, sleep quality tentatively predicted next-day pain (p=.063). No other day-to-day associations were present. Mental distress was the strongest predictor of pain, but it did not modify the sleep-pain associations, nor did season. In conclusion pain, sleep quality and mental distress are closely related, underscoring the importance of encompassing this complexity in assessment and treatment of patients with chronic pain.

National Estimates of Chronic Musculoskeletal Pain and Its Treatment in Children, Adolescents, and Young Adults in the United States: Data From the 2007-2015 National Ambulatory Medical Care Survey

To portray physician office visits by young Americans with chronic musculoskeletal pain; to describe clinical management in this group; and to explore factors associated with prescribed treatments. Using nationally representative data of ambulatory physician office visits (2007-2015 United States National Ambulatory Medical Care Survey), we identified and cross-sectionally analyzed visits by persons <25years of age diagnosed with a chronic musculoskeletal pain condition. There were 28.6 million visits over the 9-year period for chronic musculoskeletal pain for persons <25years of age, (average 3.2 million visits/year). There were more visits among older age groups, female persons, non-Hispanic White ethnicity/race, and those with more medical visits in the past year. Nonopioid medications were the most frequent treatments in all age groups (range 38.5%-48.8%). Opioids were rarely prescribed for children and adolescents but were prescribed in 23% of visits among young adults (18-24years of age). Health education and counseling were consistently prescribed at 20% of visits and physical therapy (range 9.5%-23.7%) and other treatments were less frequently prescribed. Age, sex, payment source, and physician specialty were associated with various treatments. There were over 3 million annual visits for chronic musculoskeletal pain in young Americans; these increased with age. Pharmacologic treatment is used more than nonpharmacologic approaches, and opioid prescribing in the 18- to 24-year-old age group approaches estimates in adults with musculoskeletal pain.

Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths.

Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.

Cost of Medications, Preference and Willingness-to-Pay for Pain Relief among Adult Patients Diagnosed with Acute and Chronic Musculoskeletal Pain Conditions

Objective. To determine the current cost, medication preferences, willingness to pay for symptom relief and reducedadverse events of adult patients with acute and chronic musculoskeletal pain.&#x0D; Methods. This was a cross-sectional study among adult Filipinos consulted for musculoskeletal conditions at FamilyMedicine Clinic. Data were collected through a questionnaire and a systematic sampling of respondents.&#x0D; Results. The study had a total of 342 participants with degenerative osteoarthritis as the most common primarydiagnosis. Twenty percent (N=69/342) were acutely symptomatic while 273/342 (80%) have chronic musculoskeletalpain. Most would prefer medicines at a lower price point, effectively reduces pain, fast onset of action, longertherapeutic effects and less adverse effects. Willingness-to-pay was at an average price of Php 86.11 (SD±15.47)per pill for complete symptom relief.&#x0D; Conclusion. Adult Filipinos with musculoskeletal pain symptoms prefer pain medicines with good symptom control,less adverse event and were willing to pay for complete symptom relief at an average of eighty-six pesos per pill.

Grand Challenges in Musculoskeletal Pain Research: Chronicity, Comorbidity, Immune Regulation, Sex Differences, Diagnosis, and Treatment Opportunities.

Musculoskeletal pain involves bones, joints, and related muscular tissues and includes most debilitating pain conditions such as low back pain, arthritic pain, and widespread muscle pain. Chronic musculoskeletal pain is the most predominant among chronic pain conditions and presents a serious challenge to primary care. Pain arising from musculoskeletal tissues is characteristic of deep pain and has important differences from that of cutaneous pain [Table 1; (1)]. Compared to cutaneous tissue injury, the injection of the same amount of inflammatory agent into the joint induces more intense inflammation and greater and more widespread neuronal activation in the pain transmission pathways (2). Musculoskeletal nociceptive inputs appear more effective in inducing neuronal excitation and produce greater sensory disturbances (3, 4), which may explain predominant chronic pain conditions involving deep tissues. The underlying etiology and pathology of chronic musculoskeletal pain conditions are poorly understood even after decades of research. TABLE 1 | Comparison of musculoskeletal and cutaneous pain.

Acupuncture and Chronic Musculoskeletal Pain.

Chronic musculoskeletal pain (CMP) attributable to conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain is the most common cause of disability globally, for which no effective remedy exists. Although acupuncture is one of the most popular sensory stimulation therapies and is widely used in numerous pain conditions, its efficacy remains controversial. This review summarizes and expands upon the current research on the therapeutic properties of acupuncture for patients with CMP to better inform clinical decision-making and develop patient-focused treatments. We examined 16 review articles and 11 randomized controlled trials published in the last 5years on the clinical efficacy of acupuncture in adults with CMP conditions. The available evidence suggests that acupuncture does have short-term pain relief benefits for patients with symptomatic knee osteoarthritis and chronic low back pain and is a safe and reasonable referral option. Acupuncture may also have a beneficial role for fibromyalgia. However, the available evidence does not support the use of acupuncture for treating hip osteoarthritis and rheumatoid arthritis. The majority of studies concluded the superiority of short-term analgesic effects over various controls and suggested that acupuncture may be efficacious for CMP. These reported benefits should be verified in more high-quality randomized controlled trials.

Understanding Cannabis-Based Therapeutics in Sports Medicine.

With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community. A review of ClinicalTrials.gov, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search. Clinical review. Level 3. At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time. Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.

INYBI: A New Tool for Self-Myofascial Release of the Suboccipital Muscles in Patients With Chronic Non-Specific Neck Pain: A Randomized Controlled Trial.

A randomized, single-blinded (the outcome assessor was unaware of participants' allocation group) controlled clinical trial. To investigate the effects of myofascial release therapy (MRT) over the suboccipital muscles, compared with self-MRT using a novel device, the INYBI tool, on pain-related outcomes, active cervical mobility, and vertical mouth opening, in adults with chronic non-specific neck pain (NSNP). MRT is used to manage chronic musculoskeletal pain conditions, with purported positive effects. The efficacy of self-MRT, compared with MRT, has been scarcely evaluated. Fifty-eight participants (mean age of 34.6 ± 4.7 yrs; range 21-40 yrs; 77.6% females, 22.4% males) with persistent NSNP agreed to participate, and were equally distributed into an INYBI (n = 29) or a control group (n = 29). Both groups underwent a single 5-minutes intervention session. For participants in the control group, MRT of the suboccipital muscles was performed using the suboccipital muscle inhibition technique, while those in the INYBI group underwent a self-MRT intervention using the INYBI device. Primary measurements were taken of pain intensity (visual analogue scale), local pressure pain sensitivity, as assessed with an algometer, and active cervical range-of-movement. Secondary outcomes included pain-free vertical mouth opening. Outcomes were collected at baseline, immediately after intervention and 45 minutes later. The analysis of variance (ANOVAs) demonstrated no significant between-groups effect for any variable (all, P > 0.05). In the within-groups comparison, all participants significantly improved pain-related outcomes, and showed similar positive changes for mouth opening. Cervical range-of-movement- mainly increased after intervention for participants in the control group. Both, MRT and self-MRT using the INYBI, are equally effective to enhance self-reported pain intensity, and local pressure pain sensitivity in chronic NSNP patients. For cervical mobility, MRT appears to be slighlty superior, compared with the INYBI, to achieve improvements in this population. 2.

Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review

ObjectivePrimary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical...

Evaluation of the efficacy of an internet-based pain education and exercise program for chronic musculoskeletal pain in comparison with online self-management booklet: a protocol of a randomised controlled trial with assessor-blinded, 12-month follow-up, and economic evaluation

BackgroundChronic musculoskeletal pain is one of the main causes of years lived with disability and generates the highest cost of health care among chronic pain conditions. Internet-based treatments have been shown to be an alternative for the treatment of musculoskeletal conditions, in addition to reducing barriers such as travel, high demands on the public health system, lack of time, lack of insurance coverage for private care, and high costs for long-term treatment. The aim of this clinical trial is to develop and test the effectiveness and cost-effectiveness of, an internet-based self-management program based on pain education and exercise for people with chronic musculoskeletal pain.MethodsThis is a prospectively registered, assessor-blinded, two-arm randomised controlled trial with economic evaluation comparing the Internet-based pain education and exercise intervention with a control group that will receive an online booklet. One hundred and sixty patients will be recruited from Sao Paulo, Brazil. Follow-ups will be conducted in post-treatment, 6 and 12 months after randomisation. The conduct of the study, as well as the evaluations and follow-ups will be carried out entirely remotely, through online platforms and telephone calls. The primary outcome will be pain intensity at post-treatment (8 weeks) measured using the 11-item Pain Numerical Rating Scale. Secondary outcomes will be biopsychosocial factors presents in the chronic musculoskeletal pain condition. Costs due to chronic musculoskeletal pain will be also measured, and cost-effectiveness analysis from a societal perspective will performed.DiscussionOur hypothesis is that internet-based pain education and exercise will be better than an online booklet in reducing pain and improving biopsychosocial outcomes in patients with chronic musculoskeletal pain. In addition, we believe that there will be good acceptance of patients for the internet-based intervention and that internet-based intervention will be more cost effective than the online booklet.Trial registrationThe study was prospectively registered at ClinicalTrials.gov (NCT04274439, registered 18 February 2020).

Analysis of genetically independent phenotypes identifies shared genetic factors associated with chronic musculoskeletal pain conditions

Chronic musculoskeletal pain affects all aspects of human life. However, mechanisms of its genetic control remain poorly understood. Genetic studies of pain are complicated by the high complexity and heterogeneity of pain phenotypes. Here, we apply principal component analysis to reduce phenotype heterogeneity of chronic musculoskeletal pain at four locations: the back, neck/shoulder, hip, and knee. Using matrices of genetic covariances, we constructed four genetically independent phenotypes (GIPs) with the leading GIP (GIP1) explaining 78.4% of the genetic variance of the analyzed conditions, and GIP2–4 explain progressively less. We identified and replicated five GIP1-associated loci and one GIP2-associated locus and prioritized the most likely causal genes. For GIP1, we showed enrichment with multiple nervous system-related terms and genetic correlations with anthropometric, sociodemographic, psychiatric/personality traits and osteoarthritis. We suggest that GIP1 represents a biopsychological component of chronic musculoskeletal pain, related to physiological and psychological aspects and reflecting pain perception and processing.