Chronic Musculoskeletal Pain Research Articles

Cognitive behavioral therapy for insomnia in people with chronic musculoskeletal pain. A systematic review and dose-response meta-analysis

The aims were (i) to determine the effects of Cognitive behavioral therapy for insomnia (CBT-I) on sleep disturbances, pain intensity and disability in patients with chronic musculoskeletal pain (CMP), and (ii) to determine the dose-response association between CBT-I dose (total minutes) and improvements in sleep disorders, pain intensity and disability in patients with CMP. A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, CINAHL, and SCOPUS until December 17, 2023. Randomized clinical trials (RCTs) using CBT-I without co-interventions in people with CMP and sleep disorders were eligible. Two reviewers independently extracted data and assessed risk of bias and certainty of the evidence. A random effects meta-analysis was applied to determine the effects on the variables of interest. The dose-response association was assessed using a restricted cubic spline model. Eleven RCTs (n = 1801 participants) were included. We found a significant effect in favor of CBT-I for insomnia (SMD: −1.34; 95%CI: −2.12 to −0.56), with a peak effect size at 450 min of CBT-I (−1.65, 95%CI: −1.89 to −1.40). A non-significant effect was found for pain intensity. A meta-analysis of disability was not possible due to the lack of data. This review found benefits of CBT-I for insomnia compared to control interventions, with a large effect size. In addition, it was estimated that a 250-min dose of CBT-I had a large effect on reducing insomnia and that the peak effect was reached at 450 min. These novel findings may guide clinicians in optimizing the use of CBT-I in people with CMP and insomnia.

Prevalence of Spinal Segmental Sensitization Syndrome in Outpatients Attending Physical Medicine and Rehabilitation Centers for Chronic Musculoskeletal Pain: A Multicenter Study

ObjectiveTo determine the prevalence of spinal segmental sensitization (SSS) syndrome, a regional pain disorder, among patients visiting physical medicine and rehabilitation centers (PM&RCs) for chronic musculoskeletal pain (CMSP). DesignAn observational, descriptive, cross-sectional study conducted from March to July 2023. SettingSeven PM&RCs from 5 cities, representing 3 care systems: Social Security (SS), Ministry of Health (MH), and private practice (PP). ParticipantsAll patients, regardless of age, attending a physiatry consultation for CMSP for the first time and who provided informed consent to participate were included. Nonprobabilistic sampling was employed. InterventionsNot applicable. Main Outcome MeasureWe estimated the overall prevalence of SSS syndrome as a percentage among patients with CMSP, stratified by health care institution, sex, age, and occupation type. We also recorded the spinal segments involved and any concomitant painful disorders (CPDs). SSS syndrome was diagnosed using standardized criteria. ResultsOf the eligible participants, 319 with CMSP were enrolled; 73.4% were women, and the median age of participants was 56.9 (range, 13-89y) years. The overall prevalence of SSS syndrome was 53.3%. Of these, 69.1%, 42.2%, and 13.8% were in the SS, MH, and PP systems, respectively. The most affected were female participants (56.4%), those aged 50-64 years (60.4%), and those with active jobs (58.8%). Most commonly, the lumbosacral and lumbar segments were affected, followed by the lower and middle cervical levels. Spine pathologies were the most common CPDs. ConclusionThe prevalence of SSS syndrome was high among patients who visited PM&RCs for CMSP and varied according to the care system. Further research on SSS syndrome is warranted to relieve the burden it poses on patients with CMSP and ensure proper diagnosis in clinical practice.

Health Care Discrimination Affects Patient Activation, Communication Self-Efficacy, and Pain for Black Americans

This study examines whether a key psychosocial factor—perceiving racial discrimination in health care—is associated with worse patient activation, communication self-efficacy, and physical health outcomes for Black veterans with chronic pain. Moreover, we explore the role of physician-patient working alliance as a moderator that may alleviate the potential consequences of perceiving racial discrimination. This work is a secondary analysis of baseline data from a clinical trial with 250 U.S. Black veterans with chronic musculoskeletal pain. Participants were recruited from primary care clinics at a Midwestern VA hospital between 2018 and 2021. Perceiving racial discrimination in health care was associated with lower patient activation, lower self-efficacy in communicating with one’s physician, higher pain intensity, and lower pain management self-efficacy (ps < .049) but was unrelated to reports of pain interference or use of pain coping strategies (ps > .157). Although the relationship between perceived discrimination and patient activation was moderated by working alliance (P = .014), having a stronger working alliance improved patient activation to varying degrees across levels of perceived discrimination (rather than buffering against negative outcomes when perceiving higher levels of discrimination). Moderation was not significant on any other measures. This study deepens our understanding of the broad range of health outcomes that are (not) associated with perceiving racial discrimination in health care. Contrary to prior theorizing, this work also indicates that having a strong working alliance does not attenuate the consequences of perceiving discrimination among Black individuals living with pain. These results highlight the need for system-level interventions to address perceptions of racial mistreatment in health care. PerspectiveThis work has important public health implications by identifying the broad range of outcomes associated with perceived discrimination in health care among Black Americans. Importantly, a strong physician-patient relationship did not buffer Black individuals from the consequences of perceiving discrimination. These findings inform intervention targets to mitigate racial health disparities.

Supplements in Rare Bone Diseases

AbstractDespite having different aetiologies, different rare bone diseases (RBDs) such as hypophosphatasia (HPP), autosomal dominant hypophosphatemic rickets (ADHR), X-linked hypophosphatemia (XLH) and osteogenesis imperfecta (OI) share common clinical features such as growth disturbances, pathological fractures, pseudo-fractures and chronic musculoskeletal pain. The role of micronutrients including minerals, trace elements and vitamin D in the physiological bone metabolism are well established. A significant share of RBD patients suffer from nutritional deficiencies due to the underlying disease or do not achieve the recommended daily intake (RDI) for micronutrients. The supplementation of micronutrients in RBDs should have the goal of achieving the RDI and promoting bone metabolism without increasing the burden of disease. Specific diets and an increased intake of specific micronutrients could potentially improve some of the disease symptoms, however special caution should be taken to avoid over-supplementation and to avoid adverse effects such as hypercalciuria, ectopic calcifications, GI-upset and nephrocalcinosis in case of calcium over-supplementation.

Navigating Online Health Information: Assessing the Quality and Readability of Dietary and Herbal Supplements for Chronic Musculoskeletal Pain.

Navigating Online Health Information: Assessing the Quality and Readability of Dietary and Herbal Supplements for Chronic Musculoskeletal Pain.

The Influence of Psychological Factors on Physical Activity in Individuals With Patellofemoral Pain.

Patellofemoral pain (PFP) is a prevalent chronic condition characterized by retropatellar or peripatellar pain exacerbated by various knee flexion-based activities. Previous research has highlighted the impact of psychological constructs on pain and function in chronic musculoskeletal pain conditions, yet their influence on physical activity in PFP cohorts remains unexplored. We aimed to evaluate whether pain self-efficacy and pain catastrophizing predict variations in steps per day and moderate to vigorous physical activity (MVPA) among individuals with PFP. Cross-sectional observational study. Thirty-nine participants (11 males) with PFP were included. Dependent variables were steps per day and minutes of MVPA. Independent variables were pain self-efficacy and pain catastrophizing, measured by the pain self-efficacy questionnaire and the pain catastrophizing scale. Participants were given an ActiGraph wGT3X-BT for 7days to assess physical activity. Correlations were assessed between psychological measures and physical activity, and a simple linear regression was performed on psychological variables that correlated with physical activity. Alpha was set a priori at P < .05. Pain self-efficacy scores displayed a moderate association with steps per day (rho = .45, P = .004) and a weak association with MVPA (rho = .38, P = .014). Pain catastrophizing scores exhibited no significant associations with physical activity (P < .05). Regression models affirmed pain self-efficacy scores as significant predictors of both steps per day (F1,37 = 10.30, P = .002) and MVPA (F1,37= 8.98, P = .004). Psychological measures continue to demonstrate value to clinicians treating PFP. Pain self-efficacy scores were moderately associated with steps per day and weakly associated with MVPA, explaining nearly a fifth of the variation in physical activity. Clinicians should prioritize the assessment of pain self-efficacy when treating individuals with PFP, potentially employing psychological interventions to improve physical activity in the PFP population.

The analgesic tolerance to electroacupuncture in patients with chronic musculoskeletal pain: an observational pilot study

The analgesic tolerance to electroacupuncture in patients with chronic musculoskeletal pain: an observational pilot study

Particle behaviors of Imipenem/Cilastatin in various liquids investigated by chemical structures and temporal microscope observations

Imipenem/Cilastatin (IPM/CS) is currently used as an embolic agent in transarterial embolization for chronic musculoskeletal pain due to its efficacy of short-term blood flow occlusion. However, due to its off-label use, the development of new materials to substitute IPM/CS is needed. Therefore, investigating the behavior of IPM/CS particles becomes crucial. In this paper, we observed the changes in particle size of IPM/CS when dissolved in phosphate-buffered saline, normal saline, iodinated contrast agent and water. The results indicated that the particle size of IPM/CS ranged from 16 to 57 µm and has fastest hydrolysis rate in iodinated contrast agent. And we analyzed the possible structure of hydrolyzed product of IPM/CS in water at room temperature and 37 ℃ using 1HNMR, HPLC. The results suggested Cilastatin is stable at both temperatures, while Imipenem hydrolyzed to produce slightly different products at different temperatures.

PT-IN-MIND: study protocol for a multisite randomised feasibility trial investigating physical therapy with integrated mindfulness (PT-IN-MIND) for patients with chronic musculoskeletal pain and long-term opioid treatment who attend outpatient physical therapy

IntroductionMany individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to...

Peripheral macrophages contribute to nociceptor priming in mice with chronic intermittent hypoxia.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that is associated with increased incidence of chronic musculoskeletal pain. We investigated the mechanism of this association in a mouse model of chronic intermittent hypoxia (CIH) that mimics the repetitive hypoxemias of OSA. After 14 days of CIH, both male and female mice exhibited behaviors indicative of persistent pain, with biochemical markers in the spinal cord dorsal horn and sensory neurons of the dorsal root ganglia consistent with hyperalgesic priming. CIH, but not sleep fragmentation alone, induced an increase in macrophage recruitment to peripheral sensory tissues (sciatic nerve and dorsal root ganglia), an increase in inflammatory cytokines in the circulation, and nociceptor sensitization. Peripheral macrophage ablation blocked CIH-induced hyperalgesic priming. The findings suggest that correcting the hypoxia or targeting macrophage signaling might suppress persistent pain in patients with OSA.

Pain Sensitivity Questionnaire: Cross-cultural adaptation and validation of the Greek version.

The Pain Sensitivity Questionnaire (PSQ) was developed to assess general pain sensitivity. This study aimed to validate the Greek version of PSQ. The questionnaire was translated into Greek (PSQ-GR) and piloted in a small sample of patients with chronic pain (n=35). A total of 146 chronic pain patients and healthy volunteers completed the PSQ-GR, the Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS) and Central Sensitization Inventory (CSI). To evaluate the test-retest reliability, 36 volunteers completed the PSQ-GR twice over 7±2days. Internal consistency was excellent (Cronbach's alpha 0.90-0.96) for PSQ-total, PSQ-minor, and PSQ-moderate. The Intraclass Correlation Coefficient was estimated at 0.90-0.96 for PSQ-total, PSQ-minor and PSQ-moderate and the SEM was 0.59-0.90 for PSQ-total, PSQ-minor and PSQ-moderate approximately. The smallest detectable change was 0.48 for PSQ-total, 0.47 for PSQ-minor and 0.44 for PSQ-moderate. Positive and significant correlations were observed between PSQ-GR and HADS (r=0.38, p<0.01), PCS (r=0.41, p<0.01) and CSI (r=0.30, p<0.01). Statistically significant differences in PSQ-GR scores were identified between the healthy volunteers and the chronic pain patients. The PSQ-GR is a reliable and valid tool that can assess pain sensitivity in healthy individuals and chronic musculoskeletal pain patients.

Exploring Factors Associated with Changes in Pain and Function Following mHealth-Based Exercise Therapy for Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis and Meta-Regression

Exercise therapy is the first-line intervention recommended for those with chronic musculoskeletal pain (CMP). Smartphone technologies (mHealth) represent a feasible means for exercise prescription and individualization. This systematic review with meta-analysis aimed to identify factors associated with changes in pain and function following mHealth-based exercise therapy in patients with CMP. CINAHL (via EBSCOhost), Embase, PubMed, Scopus, and SPORTdiscus were searched from inception to February 2023. Observational and controlled clinical trials with correlation or regression analysis of factors associated with the effect of mHealth exercise interventions on pain and function were included. The risk of bias, completeness of interventions, spin of information, and certainty in the evidence were evaluated. Eight studies with 51,755 participants were included. Reduced pain intensity after intervention was associated with higher physical function: r (95% CI) = −0.55 (−0.67 to −0.41); I2 = 86%, Tau2 = 0.02; p &lt; 0.01. Meta-regression identified the Body Mass Index (BMI), exercise dose, and completion rate as potential moderators between changes in pain and physical function following mHealth exercise therapy. No association was found between pain and anxiety: r (95% CI) = 0.15 (−0.08 to 0.37); I2 = 87%, Tau2 = 0.02; p = 0.19. Very low certainty in the evidence was observed due to serious concerns regarding the risk of bias, inconsistency, and indirectness. The limited available evidence detracts from the clinical interpretation of the findings.

Turkish cross-cultural adaptation, construct validity, and reliability of the treatment expectations in chronic pain scale.

Measuring treatment expectations using the Treatment Expectations in Chronic Pain (TEC) scale has the potential to help clinicians and researchers better understand the role that treatment expectations play within the framework of multimodal pain management settings. The purpose of this study is to determine the cross-cultural adaptation, construct validity and reliability of the TEC Scale in the Turkish language. The study included 191 volunteers aged 22-65 with chronic musculoskeletal diseases. This study composed of a six-stage cross-cultural adaptation process, which included translation, translation synthesis, back-translation, expert committee review, pre-testing and documentation submission. The Positivity Scale and Illness Cognition Questionnaire were used to measure convergent validity while the Hospital Anxiety and Depression Scale was used to test divergent validity. The psychometric properties of the Turkish version of the TEC scale was examined by confirmatory factor analysis (CFA). Scale's internal consistency was examined using Cronbach's alpha. Pearson correlation coefficients were utilized to evaluate both convergent and divergent validity. The significance level was set at p < .05. The results of the CFA showed that factor structure of predicted subscale fitted well the data (x2/df = 3,07;CFI = 0,91,IFI = 0,91 TLI = 0,87,RMSEA = 0,10). The results of the CFA indicated that factor structure of ideal subscale fitted well with the data (x2/df = 2,38;CFI = 0,92,IFI = 0,93,TLI = 0,90,RMSEA = 0,08). Both subscales of the TEC were strongly correlated. The predicted subscale had moderate relationships to depression, anxiety, and positivity (r=-0.37 to r = 0.55) but poor correlations with measures of acceptance, perceived benefits and helplessness (r=-0.24 to 0.35). The ideal subscale had moderate correlations with measures of positivity (r = 0.36) and depression (r=-0.38) but poor correlations with measures of acceptance, perceived benefits helplessness and anxiety (r = 0.14). The Turkish version of the TEC scale is acceptable, valid, and reliable for use in Turkish patients with chronic musculoskeletal pain in physiotherapy outpatient practice.

Chronic Musculoskeletal Pain and Central Sensitization-Related Symptoms in Chilean Victims of Political Violence During the 1973 to 1990 Dictatorship.

People who suffer political violence (PV) are at risk of developing mental illness, chronic noncommunicable diseases, chronic pain, and decreased life expectancy. However, these indicators have been studied primarily in war veterans and refugees. The objective of this study was to estimate the prevalence of chronic musculoskeletal pain (CMP) and central sensitization-related symptoms (CSRS) in Chilean victims of PV during the 1973 to 1990 dictatorship. A cross-sectional observational multicenter study was conducted. Three hundred twenty-five people from six centers of a Ministry of Health of Chile program participated. The presence of CMP was determined by a history of pain ≥3 months, and CSRS was determined using the central sensitization inventory. About 69.23% of the sample had CMP (76.85% of females and 56.56% of males). About 60% of people with CMP showed a high level of CSRS severity (66.67% females and 44.93% males). Females presented significantly higher proportions of CMP (p < .001), and there was an association between CSRS severity and being female (p = .004). Chilean victims of PV during the 1973 to 1990 dictatorship presented a high prevalence of CMP and high-level CSRS severity. Both conditions affected females more than males. Future studies are needed to further delve into these variables' behavior and their influence on the quality of life in this population.

Fibromyalgia and Skin Disorders: A Systematic Review.

Background: Fibromyalgia is a complex multifaceted syndrome primarily characterised by chronic musculoskeletal pain, fatigue, and functional symptoms. Although FM is known to be associated with several comorbidities, the aim of this systematic review was to comprehensively examine the available evidence regarding the relationship between FM and dermatological manifestations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and MedLine and Web of Science (WOS) databases were searched up to June 2023. After removing duplicate records, 21 articles were deemed eligible for inclusion in the qualitative synthesis. Results: Overall, the included studies revealed an increased frequency of FM among patients with cutaneous diseases, including psoriasis, chronic urticaria, contact allergy, acneiform disorders, hidradenitis suppurativa, and vitiligo. Additionally, the presence of comorbid FM may intensify skin conditions, which has a negative impact on quality of life and vice versa. Conclusions: Although the causal mechanisms of FM are still far from being understood, this systematic review suggests a relationship between FM and skin disorders. However, further research is encouraged in this area.

Systematic Review of the Psychopathological Symptomatology and Neuropsychological Disorders of Chronic Primary Musculoskeletal Pain.

Chronic pain can develop without tissue damage, injury, or underlying illness. There are several intervening biological, psychological, and social factors involved in its appearance that significantly affect the activities of daily life. It is also associated with significant emotional anxiety and/or functional disability. This review systematically analyses works published in the last five years that evaluate the psychopathological symptomatology and neuropsychological disorders of chronic primary musculoskeletal pain (CPMP). A bibliographic search was carried out to identify articles published in English between January 2018 and March 2023 using the Medline, Scopus, PsycInfo, and Pubmed databases. Twenty articles were obtained using the PRISMA selection method. The main results of this study provided evidence of the presence of moderate and severe chronic pain in patients suffering from musculoskeletal pain. This increase in the intensity of pain correlates with greater psychopathological symptomatology, such as depression, anxiety, insomnia, lack of attention, and hyperactivity/impulsiveness, as well as the use of maladaptive coping strategies. Furthermore, there exists dysfunction in the cerebral structures related to attention and the processing of pain in patients with CPMP. This review may help to develop and optimise the multidisciplinary treatments adapted to the deficits caused by this illness.

The Effectiveness of Auricular Acupressure on Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: To assess the effectiveness of auricular acupressure (AA) in managing pain and disability in individuals with chronic musculoskeletal pain. Materials and Methods: A systematic search on six electronic databases was performed from their inception to May 7, 2023, to identified relevant randomized controlled trials (RCTs). Two independent reviewers screened the abstracts and full texts, extracted data, and assessed risk of bias using RoB 2. The primary outcomes were pain intensity and disability. The secondary outcomes were pain pressure thresholds, pain catastrophizing level, and fear avoidance beliefs. A random-effects model was used for meta-analyses. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. Sensitivity analyses were conducted after removing low-quality papers. Results: Of 633 identified records, six studies involving 496 participants were included. All included studies compared the effectiveness of AA with sham controls in treating various chronic musculoskeletal pain. Four meta-analyses were conducted to compare the effectiveness of AA with sham controls. Low-quality evidence supported that AA had a large effect size on postintervention subjective pain reduction (standardized mean difference [SMD] = -0.95; 95% confidence interval [CI]: -1.36 to -0.54; p = 0.00; I2 = 52.61%); moderate-quality evidence substantiated that AA had a large effect size on enhancing postintervention pressure pain threshold (SMD = -0.55; 95% CI: -0.88 to -0.23; p = 0.00; I2 = 0%). There was low-quality evidence that AA had a large effect on reducing postintervention disability (SMD = -0.68; 95% CI: -1.24 to -0.12; p = 0.02; I2 = 51.33%). Our sensitivity analysis reaffirmed the same conclusion regarding pain reduction immediately after the intervention. Fourteen participants reported minimal adverse events, including soreness, tenderness, irritation, and redness, which disappeared within 1-7 days. Discussion: Our systematic review revealed that AA significantly improved pain, pressure pain thresholds, and disability in individuals with various chronic musculoskeletal pain conditions immediately post-treatment compared with sham treatment. Given the paucity of studies and inconsistent protocols, future RCTs are warranted to evaluate the effectiveness of AA in people with chronic musculoskeletal pain at a longer follow-up with detailed protocols, which allows researchers and clinicians to optimize AA intervention. Conclusion: AA has immediate post-treatment benefits for chronic musculoskeletal pain, whereas its effects at the 1- or 6-month follow-up remain uncertain.

Assessing the Quality and Reliability of Videos Related to Fibromyalgia on TikTok: A Comprehensive Analysis.

Introduction Fibromyalgia, characterized by chronic musculoskeletal pain and associated symptoms, poses significant challenges in diagnosis and management. While social media platforms like TikTok have emerged as popular sources of health information, their variable content quality necessitates critical evaluation. This study aimed to assess the quality and reliability of TikTok videos related to fibromyalgia, thereby enhancing the understanding of their impact on patient education and self-management. Methods A cross-sectional observational study was conducted in June 2024, which analyzed 150 TikTok videos using search terms like "Fibromyalgia", "Fibromyalgia Symptoms", and "Fibromyalgia Treatment". Videos were evaluated for inclusion based on relevance and language (English), by employing the Global Quality Scale (GQS) and Quality Criteria for Consumer Health Information (DISCERN) score for assessment. Statistical analysis was performed by using IBM SPSS Statistics v21.0 (IBM Corp., Armonk, NY). The Kruskall-Wallis test was employed, and a p-valueless than 0.05 was deemed statistically significant. Results Of the 150 videos initially reviewed, 96 (64%) met the inclusion criteria. Content categories included disease description (34, 35.42%), symptoms (81, 84.38%), management (64, 66.67%), and personal experiences (63, 65.63%). The videos were uploaded by doctors (8, 8.33%), patients (63, 65.63%), healthcare workers ( 7, 7.29%), and others (18, 18.75%). Mean GQS scores varied significantly by uploader type: doctors (4.63 ± 0.52), healthcare workers (3.43 ± 0.79), patients (2.37 ± 0.81), and others (2.11 ± 0.47) (p<0.001). DISCERN scores followed a similar trend: doctors (3.88 ± 0.64), healthcare workers (2.14 ± 1.46), patients (1.08 ± 0.27), and others (1.61 ± 0.50) (p<0.001). Conclusions TikTok serves as a pivotal platform for fibromyalgia-related discourse, predominantly shaped by patient-generated content. However, even though it provides insights into symptoms and management strategies, gaps exist in comprehensive medical guidance and preventive measures. The study underscores the critical role of healthcare professionals in enhancing content reliability and educational value on social media. Future research should explore cultural and linguistic diversity to broaden the accessibility and relevance of health information on platforms like TikTok.

Holistic Care for People Living With Chronic Musculoskeletal Pain: The Relevance and Importance of Sexual Function.

Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships.

Recovering Work Productivity in a Population With Chronic Musculoskeletal Pain: Unveiling the Value and Cost-Savings of a Digital Care Program.

To investigate potential savings obtained from restoring productivity in employees with chronic MSK pain through a digital care program (DCP). Secondary analysis of a prospective longitudinal study assessing cumulative savings overall or across several industry sectors by analyzing changes in Work Productivity and Activities Impairment (WPAI questionnaire). Employees from 50 U.S. states started the program ( n = 5032). Significant improvements in productivity impairment were observed across all industries, yielding median cumulative savings from $151 (95% confidence interval [CI], 128-174) to $294 (95% CI, 286-303) per participant at treatment end. Twelve-month projections estimated median savings of $2916 (95% CI, 2861-2972). Additionally, significant improvements in non-work-related daily activities were observed. This study underlines the burden of MSK-related productivity loss on employers' financial balance, illustrating the importance of a DCP to assist patients to recover quality of life and succeed professionally.