Management Of Musculoskeletal Pain Research Articles

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.

Most physical interventions for musculoskeletal pain in children and adolescents cannot be reproduced in clinical practice: a meta-research study of randomized clinical trials

IntroductionConservative treatments such as physical therapies are usually the most indicated for the management of musculoskeletal pain; therefore, a detailed description of interventions enables the reproducibility of interventions in clinical practice and future research. The objective of this study is to evaluate the description of physical interventions for musculoskeletal pain in children and adolescents.MethodsWe considered randomized controlled trials that included children and adolescents between 4 and 19 years old with acute or chronic/persistent musculoskeletal pain. We included physical therapies related to all types of physical modalities aimed at reducing the intensity of pain or disability in children and adolescents with musculoskeletal pain. The description of interventions was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. We performed electronic searches in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PsyINFO and PEDro up to April 2024. The description of physical interventions was presented using frequencies, percentages and 95% confidence intervals (CIs) of the TIDieR checklist items described in each study. We also calculated the total TIDieR score for each study and presented these data as mean and standard deviation.ResultsWe included 17 randomized controlled trials. The description measured through the TIDieR checklist scored an average of 11 (5.2) points out of 24. The item of the TIDieR that was most described was item 1 (brief name) and most absent was item 10 (modifications).ConclusionThe descriptions of physical interventions for the treatment of musculoskeletal pain in children and adolescents are partially described, indicating the need for strategies to improve the quality of description to enable true clinical reproducibility.

Neuropathic component of chronic musculoskeletal pain in patients with post-COVID-19: A cross-sectional study

Objectives: This study aimed to evaluate the neuropathic component of chronic musculoskeletal pain in post-coronavirus disease 2019 (COVID-19) and examine the relationship between neuropathic pain and clinical and demographic characteristics. Patients and methods: This cross-sectional study included 163 adult patients (85 females, 78 males; mean age: 41.7±4.3 years; range, 22 to 50 years) with post-COVID-19 musculoskeletal pain between February 1, 2021, and April 30, 2021. Demographic and clinical characteristics, including age, sex, affected site, duration, and severity of post-COVID-19 musculoskeletal pain using the Visual Analog Scale (VAS), as well as a neuropathic component of pain using the Leeds assessment of neuropathic symptoms and signs (LANSS), were collected. The most common post-COVID-19 symptoms, presence of hospitalization, and length of hospital stay during active COVID-19 infection were recorded from the patient records. Results: The mean duration and severity of pain were 7.85±1.53 months and 5.09±1.95, respectively. Half of the patients were hospitalized, and the mean length of hospital stay was 12.15±18.06 days. The most common pain sites were upper and lower back pain, followed by leg and arm pain. A total of 92 (56.4%) patients had previously received pharmacological or nonpharmacological treatment for post-COVID-19 musculoskeletal pain. Based on the LANSS (scores >12), 31 (19%) patients had neuropathic pain. There was a significant correlation between the presence of neuropathic pain and pulmonary involvement/symptoms. The presence and length of hospital stay were correlated with LANNS scores (p<0.05). The frequency, LANSS scores, and VAS-pain scores of the patients with and without neuropathic pain were similar between male and female patients (p>0.05). Conclusion: The neuropathic component of chronic musculoskeletal pain may be common, as one-fifth of our patients had neuropathic pain as assessed by the LANNS. Therefore, the awareness of post-COVID-19 chronic neuropathic musculoskeletal pain should be increased. We believe that focusing on the identification of pain phenotypes would provide adequate and tailored chronic neuropathic musculoskeletal pain management in the post-COVID-19 period.

Development and validation of the Italian version of the pain attitudes and beliefs scale-musculoskeletal (PABS-MSK) among physiotherapists working with patients with musculoskeletal chronic pain

BackgroundDue to their high prevalence, long-term disability, work absenteeism, and low productivity capacity they often lead to, nociplastic and chronic pain are a major public health and social concern. Although high-level literature recommends the Biopsychosocial model, the traditional Biomedical approach is still very diffuse in clinical practise. It is recognized that the beliefs and attitudes of clinicians have an impact on those of patients. The Exploratory Factor Analysis (EFA) was used to validate the Italian version of the PABS-MSK questionnaire. ObjectivesThe aim of this study was to translate the original PABS-MSK items into Italian and then assess the construct validity of the new Italian version of the PABS-MSK questionnaire, addressed to physiotherapists, to gain knowledge about physiotherapists’ attitudes and beliefs toward the management of chronic musculoskeletal pain and to correlate them with individual characteristics. MethodsAn EFA was performed to validate the modified-Italian-PABS-MSK questionnaire. Furthermore, multivariable regression models were implemented to assess any statistically significant differences in the total score of the two dimensions for sociodemographic and occupational characteristics. ResultsThe sample consisted of 563 subjects who are members of the order of physiotherapists.The Parallel Analysis suggested extracting two factors, and the EFA showed that the first scale (which we called Biopsychosocial) had higher factor loadings values, while two items (7 and 19) did not adequately represent the other scale (Biomedical).Moreover, the regression models showed that younger and freelance clinicians are more prone to adhere to the Biopsychosocial model. ConclusionsThe modified-Italian-PABS-MSK questionnaire appears to measure two factors related to the Biopsychosocial and Biomedical beliefs of physiotherapists in the management of chronic musculoskeletal pain. The results suggest that professional training based on the evidence and recommendations of international guidelines is necessary to improve the adherence of physiotherapists to the Biopsychosocial model. However, additional studies are needed to further validate the scales, and assess the test-retest reliability, responsiveness, and construct validity.

Current Indications and Future Direction in Heat Therapy for Musculoskeletal Pain: A Narrative Review

Background: Musculoskeletal pain is a non-negligible multifaceted condition affecting more than 30% of the global population. Superficial heat therapy (HT), through increasing tissue temperatures, plays a role in increasing local metabolism and function and relieving pain. Knee (KP) and sports pain represent two relevant fields of superficial HT application. Methods: In the present paper, a panel of experts performed a narrative review of the literature regarding the role of superficial HT in the management of knee and sports activity-related pain. Results: According to the reviewed literature, HT represents a therapeutic option in the management of musculoskeletal pain due to three main effects: pain relief, promotion of healing, and return to normal function and activity. Moreover, HT plays a role in sport activities both before and after exercise. Before performing sports, HT helps in preparing muscles for performance. After performing sports, it is capable to promote recovery and healing pathways. Combining and sequencing superficial heat and cold therapy represent an interesting topic of study. Overall, the application of heat wraps for superficial HT can be considered safe. Conclusions: HT has been shown to be a potentially beneficial and safe option in the management of several conditions including KP and sports. The key in the application of superficial HT is a multimodal and multidisciplinary approach.

Penetration capacity and local anti-inflammatory effect of a methyl salicylate gel with turpentine essence, camphor, and menthol for the symptomatic local treatment of muscular and joint pains

Oral non-steroidal anti-inflammatory drugs (NSAIDs) are effective in managing musculoskeletal pain, but often are associated with side effects. Therefore, topical anti-inflammatory drugs are considered a suitable alternative for certain patients. To determine the skin penetration capacity and anti-inflammatory efficacy of a methyl salicylate gel (MS) with turpentine essence, camphor and menthol (GelSMETAM). Human skin explants were used (three biological replicates with 3 technical replicates each were performed). To assess penetration capacity, methyl salicylate (MS) levels were quantified at different intervals using liquid chromatography with tandem mass spectrometry (LC-MS/MS). For the anti-inflammatory effect, the gene expression of major pro-inflammatory factors was quantified 30 minutes, 8 hours, and 12 hours after an impact; comparing GelSMETAM application with untreated controls. The results showed that approximately 0.8% of the total applied methyl salicylate penetrated the skin with a time-dependent concentration increase. The anti-inflammatory effect demonstrated a significant reduction in the gene expression of TNFα, IL1α, IL6, IL8, and NFKβ at 30 minutes (between -39% and -53.6% compared to control), which was maintained at 8 hours except for TNFα (between -59% and -92.6%) and persisted even at 12 hours (-69.4%) for IL1α. The results support the hypothesis that GelSMETAM provides an effective and prolonged anti-inflammatory response, positioning it as a suitable option for the management of musculoskeletal pain.

Current thinking in physiotherapy for the management of idiopathic and postsurgical temporomandibular disorders: a narrative review

Temporomandibular disorders (TMDs) are the second most common form of orofacial pain after an odontogenic source. Despite their complex aetiopathology they are considered a musculoskeletal disorder. They can have a significant impact on the quality of life of those suffering from TMDs, but can be treated and managed through a mixture of conservative and surgical approaches. Physiotherapists specialising in musculoskeletal therapy and pain management can offer a variety of techniques to help in the treatment and management of TMDs. In this narrative review the evolution of physiotherapy practice in the United Kingdom will be outlined, along with a discussion about physiotherapeutic theoretical frameworks in the management of musculoskeletal disorders and idiopathic TMDs. Finally, a narrative review will be presented, outlining the literature exploring the use of physiotherapy post TMJ surgery, underpinned by a systematic literature search on the topic. After screening for inclusion in the narrative review, eight articles were included for narrative synthesis. The main findings were that there is a relative paucity of studies looking at the value of physiotherapy post TMJ surgery compared with the treatment of idiopathic TMDs, and there is heterogeneity in the physiotherapy programmes described in the literature, but the addition of physiotherapy post TMJ surgery seems to augment the patient's response to surgery. The article concludes by describing the domestic challenges and opportunities of integrating physiotherapy into TMD management pathways.

Prevalence of rheumatic musculoskeletal pain and disability in rural Nepal‐ a cross‐sectional community‐based study adopting WHO‐ILAR COPCORD stage I: Phases I and II protocol

AbstractBackgroundThe burden of musculoskeletal (MSK) pain and disabilities is high in health facilities but remains unknown in the community due to a lack of community‐level studies. The community‐oriented program for control of rheumatic diseases (COPCORD) is focused on determining MSK pain and disabilities through epidemiological surveys. This study adopted the COPCORD stage I protocol to determine the prevalence of rheumatic MSK pain and disability and its associated factors in the Pyuthan district of Nepal.MethodologyA cross‐sectional community‐based study using the quantitative method was conducted in Pyuthan municipality as per COPCORD stage I protocol. COPCORD stage I (phase I and phase II) questionnaires were used to collect data through the interview technique. Populations aged 18 years and above were included in the study. A multistage sampling technique was used, and the total sample size was 2145. The collected data from phase I and phase II were entered in Epidata version 3.1. Descriptive and analytical analysis was done in SPSS. The Chi‐square test was used to find the association between dependent and independent variables.FindingsThe overall prevalence (past and current MSK pain/swelling) was 26.81% (95% CI 24.9–28.7). Current MSK pain/swelling was found in 19.53% of the participants, and past MSK pain/swelling was found in 25.87%. Among self‐reported chronic diseases, joint pain was reported by the majority of the participants (17.86%). Age, sex, education, nature of work, current smoking, tobacco use, and alcohol use were found to be associated with past and current MSK pain/swelling.ConclusionsMore than one‐fourth of the participants had MSK pain/swelling. The prevalence of MSK pain/swelling was higher in elderly participants, females, illiterates, heavy workers, smokers, tobacco users, and alcohol users. Similar studies should be conducted in other regions of the country, and this study should also be expanded to COPCORD Stages II and III to identify the risk factors and to improve the management of MSK pain and disorders.

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.

Holistic management of chronic musculoskeletal pain among elderly patients: A primary care approach

Holistic management of chronic musculoskeletal pain among elderly patients: A primary care approach

The Effect of Myofascial Stretching on Mechanical Nociception and Contributing Neural Mechanisms

Myofascial stretching is often prescribed in the management of musculoskeletal pain. However, the neural mechanisms contributing to a decrease in pain are unknown. Stretching produces a sensation that may act as a conditioning stimulus in a conditioned pain modulation response. The purpose of this study was to compare immediate changes in pressure pain thresholds (PPTs) during a low-intensity stretch, moderate-intensity stretch, and cold water immersion task. A secondary purpose was to examine if personal pain sensitivity and psychological characteristics were associated with the responses to these interventions. Twenty-seven (27) healthy participants underwent a cross-over study design in which they completed a cold water immersion task, upper trapezius stretch to the onset of the stretch sensation, and a moderate-intensity stretch. A significant condition x time effect was observed (F (8,160) = 2.85, p < 0.01, partial eta2 = 0.13), indicating reductions in pain sensitivity were significantly greater during a cold water immersion task compared to moderate-intensity stretching at minutes two and four. Widespread increases in heat pain threshold and lower pain-related anxiety were moderately correlated with the response to the cold water immersion task but not stretching. Moderate-intensity stretching may not elicit a conditioned pain modulation response possibly because the stretch was not intense enough to be perceived as painful.

Prevalence and associated factors of locomotive syndrome in young Japanese adults: a cross-sectional study

BackgroundThe onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS.MethodsThe participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression.ResultsOf the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females.ConclusionsOne in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.

Effects of Occupational Hazards, Musculoskeletal Pain, and Work on the Overall Fatigue, Anxiety, and Depression of Female Nurses

Nurses face not only musculoskeletal disorders but also psychological health issues. The purpose of this study is to analyze the factors influencing overall fatigue, anxiety, and depression, respectively, by comprehensively considering work characteristics, exposure to hazards, and the presence of musculoskeletal pain. This study used binary logistic regression to analyze factors influencing fatigue, anxiety, and depression, respectively. The independent variables were occupation; age; work experience; healthcare organization; working hours per week; shift type; exposure time to physical, biochemical, and ergonomic hazards; and the presence of back, upper limb, or lower limb pain. The factors influencing overall fatigue were shift type (p = 0.007), exposure to vibration (p = 0.042), awkward posture (p = 0.001), repetitive motion (p = 0.017), and presence of back (p = 0.002) or upper (p < 0.001) limb pain. The factors influencing anxiety were age (p = 0.031), hours worked per week (p = 0.006), performing patient lifting/carrying (p = 0.041), and presence of upper (p = 0.022) or lower (p = 0.039) limb pain. In addition, the factors influencing depression were found to be hours worked per week (p = 0.042), exposure to infection (p = 0.005), and the presence of lower limb pain (p = 0.011). This study found that musculoskeletal pain has a significant impact on psychological health problems, suggesting that integrated management of musculoskeletal pain and psychological health problems may be effective in addressing health problems in the nursing profession.

E053 The use of online platforms in the treatment of chronic musculoskeletal disease

Abstract Background/Aims Persistent pain is a common feature of rheumatic diseases, and has a significant impact on the emotional, physical and social wellbeing of individuals. Despite pharmacological treatment for inflammatory arthritis, such as rheumatoid arthritis (RA), 10-20% have features suggestive of co-existing centralised pain. These patients have worse pain, mood and sleep despite DMARD therapy. Similar to fibromyalgia (FM), non-pharmacological treatments are likely to be useful for this problem. Evidence supports cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for the management of chronic musculoskeletal pain. Unfortunately, access to services is poor for many people. This has driven the development of online treatment programmes and apps. The current study explores willingness of patients with rheumatic diseases to use online platforms in this context. Methods An observational cohort study of patients with a clinical diagnosis of either RA or FM were recruited from NHS outpatient clinics. Data collection was via the online platform Redcap. Analysis compared demographic and clinical features of those with past use of online platforms or apps for health purposes using Student’s t-test and chi squared tests. A similar comparison was conducted for future use of online platforms or apps. Results Of 343 patients 177(52%) FM, 166(48%) RA), 264 (77%) were female with mean (SD) age 48 (13.6). Past use of online platforms is summarised in Table 1. Significantly more patients with FM (70%) would be willing to try an online platform in future, compared to those with RA (30%). Those with future interest are more likely to be younger (mean age 46), have lower mood (mean PHQ-9 13), worse sleep (mean ISI 14.6) and less pain (mean VAS 6.6) compared to those who would not (mean age 60, PHQ-9 12, ISI 12.6 and VAS 7.0 respectively). Conclusion Those with FM are more likely to engage with online platforms or apps for health purposes than those with RA. In this analysis, users were more likely to be younger and experience more severe anxiety and depression but further work is needed to evaluate the contributing factors which will be essential when optimising the impact of online healthcare initiatives. Disclosure A.J.W. Wall: None. E. Kelleher: None. V. Wanigasekera: None. A. Irani (nee Soni): None.

Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the “Pain-Movement Interface” to Guide Research and Clinical Care for Musculoskeletal Pain Conditions

Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the “Pain-Movement Interface” as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PerspectiveMovement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the “Pain-Movement Interface” as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.

Evaluating the usability and effectiveness of the Go PainFree telehealth system (beta version) for musculoskeletal pain management in the Philippines

Biomechanical Taping has been shown to effectively reduce pain and enhance function in patients with musculoskeletal pain. When used as an adjunct to physiotherapy, BMT may contribute to increased stability, leading to improved pain management and functionality. Telehealth has emerged as an effective and cost-efficient alternative to traditional physiotherapy. The Go PainFree Telehealth System, employs BMT to alleviate pain and improve functionality, enhancing the overall effectiveness of online therapy services for patients with musculoskeletal conditions.The study determined the usability of the system in managing musculoskeletal conditions for patients accessing healthcare online, focusing on its usefulness, ease of use and learnability, interface quality, interaction quality, reliability, satisfaction, and future use. Also, the study examined the effectiveness of BMT on pain and function in individuals with musculoskeletal conditions when integrated into the system after a single session.This retrospective study reviewed the records of the system between November 2022 and February 2023. Evaluating the system's usability involved the integration of the Telehealth Usability Questionnaire within the system survey, serving as a reliable instrument for assessing the quality of telehealth applications from the users' perspective. Participants rated various parts, including usefulness, ease of use and learnability, interface quality, interaction quality, reliability, and satisfaction and future use. To determine the effectiveness of BMT, the 100-mm Visual Analogue Scale (VAS) was used before and after a single session. Data analysis was conducted using descriptive statistics, allowing for the summarization of demographic information and the reporting of average mean (95 % (CI)) for each usability category of the TUQ. The effectiveness of BMT on pain and function was determined using the Wilcoxon test for paired samples after one session. P < 0.05 indicates significant improvement in pain and function. This study involved 33 participants, with a mean (SD) age of 34.94 ± 2.04, who used the system between November 2022 and February 2023. The majority of reported musculoskeletal conditions pertained to the upper extremity (n = 19), followed by the lower extremity (n = 8), and spine (6). The findings revealed that participants generally considered the system useful, easy to use and learn, and had good interface and interaction quality, as shown by average scores of five in these categories, indicating "somewhat agree." Conversely, participants expressed reservations about the system's reliability, with an average score of 3 reflecting "somewhat disagree." As for their satisfaction with the system and the likelihood of future use, participants showed mixed opinions, with an average score of 4 representing "neither agree nor disagree." The study showed BMT significantly reduced pain scores (Z = −4.80, p < 0.001, two-tailed) and enhanced function scores (Z = −4.87, p < 0.0001, two-tailed) for participants with musculoskeletal conditions.The system was generally regarded by the participants as useful, user-friendly, and characterized by high-quality interface and interaction. Despite these positive perceptions, concerns about the platform's reliability emerged, and opinions about satisfaction and future use were mixed. Still, the integration of BMT into the system yielded significant reductions in pain and improvement in function for the participants with musculoskeletal conditions.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review.

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

The effectiveness of allied health and nurse practitioner models-of-care in managing musculoskeletal conditions in the emergency department: a systematic review and meta-analysis

BackgroundMusculoskeletal conditions are the most common health condition seen in emergency departments. Hence, the most effective approaches to managing these conditions is of interest. This systematic review aimed to evaluate the effectiveness of allied health and nursing models of care for the management of musculoskeletal pain in ED.MethodsMEDLINE, EMBASE, CINAHL and LILACS databases were searched from inception to March 2023 for published randomised trials that compared the effectiveness of allied health and nursing models of care for musculoskeletal conditions in ED to usual ED care. Trials were eligible if they enrolled participants presenting to ED with a musculoskeletal condition including low back pain, neck pain, upper or lower limb pain and any soft tissue injury. Trials that included patients with serious pathology (e.g. malignancy, infection or cauda equina syndrome) were excluded. The primary outcome was patient-flow; other outcomes included pain intensity, disability, hospital admission and re-presentation rates, patient satisfaction, medication prescription and adverse events. Two reviewers performed search screening, data extraction, quality and certainty of evidence assessments.ResultsWe identified 1746 records and included 5 randomised trials (n = 1512 patients). Only one trial (n = 260) reported on patient-flow. The study provides very-low certainty evidence that a greater proportion of patients were seen within 20 min when seen by a physician (98%) than when seen by a nurse (86%) or physiotherapist (77%). There was no difference in pain intensity and disability between patients managed by ED physicians and those managed by physiotherapists. Evidence was limited regarding patient satisfaction, inpatient admission and ED re-presentation rates, medication prescription and adverse events. The certainty of evidence for secondary outcomes ranged from very-low to low, but generally did not suggest a benefit of one model over another.ConclusionThere is limited research to judge the effectiveness of allied health and nursing models of care for the management of musculoskeletal conditions in ED. Currently, it is unclear as to whether allied health and nurse practitioners are more effective than ED physicians at managing musculoskeletal conditions in ED. Further high-quality trials investigating the impact of models of care on service and health outcomes are needed.

Heat therapy for different knee diseases: expert opinion.

Musculoskeletal pain is a major burden in our society. Management of musculoskeletal pain or injuries includes both pharmacological and non-pharmacological approaches, including heat therapy (HT). HT is a well-established treatment option due to its ability to promote muscle relaxation, enhance blood circulation, and modulate nociceptors with a good safety profile. The main focus of this paper is to review the available literature about HT in knee pathologies (i.e., arthrosis, arthritis, traumatic pathologies in the subacute phase, muscle and tendon pathologies linked to fatigue, muscle tension and distractions) and to provide an expert opinion in case of lack of data.

Ortho-digital dynamics: Exploration of advancing digital health technologies in musculoskeletal disease management.

Musculoskeletal (MSK) disorders, affecting billions of people worldwide, pose significant challenges to the healthcare system and require effective management models. The rapid development of digital healthcare technologies (DHTs) has revolutionized the healthcare industry. DHT-based interventions have shown promising clinical benefits in managing MSK disorders, alleviating pain, and improving functional impairment. There is, however, no bibliometric analysis of the overall trends on this topic. We extracted all relevant publications from the Web of Science Core Collection (WoSCC) database until April 30, 2023. We performed bibliometric analysis and visualization using CiteSpace, VOSviewer, and R software. Annual trends of publications, countries/regions distributions, funding agencies, institutions, co-cited journals, author contributions, references, core journals, and keywords and research hotspots were analyzed. A total of 6810 papers were enrolled in this study. Publications have increased drastically from 16 in 1995 to 1198 in 2022, with 4067 articles published in the last five years. In all, 53 countries contributed with publications to this research area. The United States, the United Kingdom, and China were the most productive countries. Harvard University was the most contributing institution. Regarding keywords, research focuses include artificial intelligence, deep learning, machine learning, telemedicine, rehabilitation, and robotics. The COVID-19 pandemic has further accelerated the adoption of DHTs, highlighting the need for remote care options. The analysis reveals the positive impact of DHTs on improving physician productivity, enhancing patient care and quality of life, reducing healthcare expenditures, and predicting outcomes. DHTs are a hot topic of research not only in the clinical field but also in the multidisciplinary intersection of rehabilitation, nursing, education, social and economic fields. The analysis identifies four promising hotspots in the integration of DHTs in MSK pain management, biomechanics assessment, MSK diagnosis and prediction, and robotics and tele-rehabilitation in arthroplasty care.