Management Of Musculoskeletal Pain Research Articles

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.

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.

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.

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.

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.

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.

Effectiveness of Träbert current in a physiotherapy program for the management of musculoskeletal pain: a systematic review and meta-analysis

IntroductionTräbert current (TC) is a physical therapy resource described for the management of musculoskeletal pain (MSP). It combines the effects of galvanism and sensory stimulation, offering various analgesic applications, although it seems that the studies that support its effectiveness are limited. The aim of this study was to evaluate the effectiveness of TC in a physical therapy plan for the management of MSP.MethodsElectronic databases reviewed included Medline (via PubMed), Web of Science, Scopus, CINAHL, Science Direct, and PEDro (last updated January 12, 2024). Randomised clinical trials (RCTs) comparing TC with other physical therapy interventions were included. Seven studies met the inclusion criteria and were analysed qualitatively, while five contributed to the meta-analysis. The clinical conditions treated included knee osteoarthritis, low back pain (LBP), and epicondylalgia. The risk of bias and internal validity was evaluated using the Rob2 tool (Cochrane) and the PEDro scale.ResultsRCTs were rated as having favourable internal validity (PEDro), despite a lack of concealed allocation and blinding, resulting in an unclear risk of bias on D2 and D5 (Rob2). The studies reported a decrease in pain and disability for the experimental groups (p &lt; 0.05), although the meta-analysis revealed a non-significant pooled effect for the standardised mean difference (SMD = 0.2–0.5, p &gt; 0.05) in favour of the controls and with heterogeneity between the studies (I2 = 50–75%).ConclusionsTC seems to be effective for the management of MSP, although it is necessary to improve the quality of the clinical trials to conduct a conclusive quantitative analysis. Key words: systematic review, transcutaneous electrical nerve stimulation, electrical stimulation therapy, Träbert current, musculoskeletal pain, musculoskeletal diseases

Novel Techniques for Musculoskeletal Pain Management after Orthopedic Surgical Procedures: A Systematic Review.

Effective postoperative pain management is critical for recovery after orthopedic surgery, but often remains inadequate despite multimodal analgesia. This systematic review synthesizes evidence on innovative modalities for enhancing pain control following major orthopedic procedures. Fifteen randomized controlled trials and comparative studies evaluating peripheral nerve blocks, local anesthetic infiltration, cryotherapy, transcutaneous electrical stimulation, adjunct medications, and other techniques are included. Thematic analysis reveals that peripheral nerve blocks and local anesthetic infiltration consistently demonstrate reduced pain scores, opioid consumption, and side effects versus conventional analgesia alone. Oral multimodal medications also show promise as part of opioid-sparing regimens. Adjunctive approaches like cryotherapy, music, and dexmedetomidine require further research to optimize protocols. Despite promising innovations, critical knowledge gaps persist regarding comparative effectiveness, optimal interventions and dosing, combination strategies, cost-effectiveness, and implementation. High-quality randomized controlled trials using standardized protocols are essential to guide the translation of enhanced multimodal regimens into clinical practice. This review provides a framework for pursuing research priorities and advancing evidence-based postoperative pain management across orthopedic surgeries.

Association of persistent musculoskeletal pain with dementia risk score in adults aged 45 years or older: The China health and retirement longitudinal study

BackgroundRecent studies have confirmed an association between pain and dementia. Whether musculoskeletal pain in the spine, upper limbs, and lower limbs is associated with dementia risk remains unclear. The longitudinal effect of musculoskeletal pain on dementia risk also remains unclear. AimsThis work aimed to investigate the association between musculoskeletal pain and dementia risk score. MethodsWe conducted cross-sectional and longitudinal analyses using data from the China Health and Retirement Longitudinal Study. Participants aged 45 years or older were recruited in 2011. A total of 10,759 participants with complete pain information at baseline were eligible for the cross-sectional analysis, and 5,855 were eligible for the longitudinal analyses. We utilized the Rotterdam Study Basic Dementia Risk Model (BDRM) to assess dementia risk. Generalized estimating equations were used to investigate the associations. ResultsCompared with participants without persistent musculoskeletal pain, those with persistent musculoskeletal pain (standardized, β = 0.83; 95 % CI: 0.06, 1.61, p = 0.036), multisite pain (sites≧5; β = 1.52; 95 % CI: 0.13, 2.91, p = 0.032), neck pain (β = 2.33; 95 % CI: 0.41, 4.25, p = 0.018), back pain (β = 2.12; 95 % CI: 0.43, 3.82, p = 0.014), waist pain (β = 1.09; 95 % CI: 0.07, 2.11, p = 0.037), shoulder pain (β = 1.74; 95 % CI: 0.46, 3.02, p = 0.008), wrist pain (β = 2.72; 95 % CI: 0.42, 5.02, p = 0.021), and knee pain (β = 1.91; 95 % CI: 0.70, 3.13, p = 0.002) had a higher BDRM score during 4 years of follow-up. ConclusionsPromoting the management of musculoskeletal pain may be beneficial in reducing the dementia risk score.

Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study.

Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood. The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health. In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants' engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale-Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P<.20 was considered significant for this pilot study. Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect -0.4, 80% CI -0.7 to -0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well. In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health. ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722.

Benign outcomes of metformin for various diseases: A review

Metformin is the most popularly prescribed first-line drug in the management of type 2 diabetes mellitus. Metformin exerts different effects such as anti- hyperglycemic effect, analgesic effect in the management of musculoskeletal pain and anti-depressant effect in depression management, cardio protective and neuroprotective effects in the cardiovascular system and central nervous system. Nrf2 is the factor responsible for enhancing the anti-oxidative effects of metformin. Metformin exerts its anti-proliferative effect through the suppression of tumor development and modifies the surroundings of the tumor.

The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management

Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from −2.0 95%CI −2.1, −1.9 to −2.1 95%CI −2.3, −1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.

Factors Influencing the Management of Musculoskeletal Pain among Children with Sickle Cell Disease in Western Kenya

Musculoskeletal pain (MSK) is a common and often distressing symptom among children diagnosed with sickle cell disease (SCD). Despite the recurrent and often severe pain episodes these children endure, there has been limited research into the factors that influence the management of this pain. This study sought to delve into the various factors that impact the management of MSK pain in children with SCD in Western Kenya. It took a comprehensive approach, considering psychological, economic, sociocultural, individual, nutritional, environmental, and hospital-related factors. To gather insights, caregivers of 176 children with musculoskeletal pain associated with SCD were interviewed using semi-structured questionnaires. Thematic analysis was employed to identify recurring themes, and a codebook was developed based on findings from the literature and emerging themes. The interviews continued until theoretical saturation was achieved, ensuring that all necessary data was collected. The results of the study revealed seven key themes that significantly influenced the management of musculoskeletal pain in these children. These themes included psychological factors, economic constraints, sociocultural beliefs, individual health status, nutritional challenges, environmental triggers, and healthcare system-related factors. Caregivers often grappled with psychological distress, financial strain, and social stigmatization. Individual factors, such as compromised immune status, played a crucial role in the frequency and severity of pain episodes. Furthermore, inadequate access to nutritious food exacerbated musculoskeletal pain. Additionally, changing weather conditions and previous negative experiences with healthcare facilities hindered effective pain management. In light of these findings, the study underscores the urgent need for a holistic approach to address these challenges. This includes providing psychosocial support, financial assistance, community awareness campaigns, improved healthcare services, education on proper nutrition, climate-related support, and healthcare worker training to better manage MSK pain in children with SCD.

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study.

Musculoskeletal pain disorders continue to be one of the leading causes of disability worldwide. Best practice care recommends patient-centred biopsychosocial models of care. Little is known about the chronic musculoskeletal pain management in low- and middle-income countries. To explore the management of chronic musculoskeletal pain by healthcare professionals in Bhutan. This study employed a qualitative design involving 19 Bhutanese healthcare professionals managing chronic musculoskeletal pain in Bhutan. We collected data using a semi-structured interview guide. Thematic analysis was done manually. Healthcare professionals reported that patients rely on a combination of home remedies and seek help from local healers and hospitals for chronic musculoskeletal pain management. While healthcare professionals understand chronic musculoskeletal pain as multi-dimensional phenomenon, the primary focus was on identifying and treating structural anomalies. Time constraints, inadequate knowledge and skills, lack of confidence, facilities and expertise were reported as barriers to the effective management of chronic musculoskeletal pain. They proposed a need for clinical guidelines, relevant skills training and creating awareness of chronic musculoskeletal pain. The management of chronic musculoskeletal pain in Bhutan is focused on identifying and treating physical abnormalities. Healthcare professionals consider psychosocial dimensions important but lack any form of actionable interventions in this domain.

Treatment of rheumatic musculoskeletal disorders.

Non-medicinal therapies with water, salts, exercise, massage, supportive devices, and electricity have been used for centuries and continue to be of benefit for some people with musculoskeletal disorders. Historical texts refer to the two electuaries mithridatium and theriaca as early therapeutic attempts of man to provide relief of musculoskeletal symptoms and attempt disease cures. For over 200years, morphine-derived products have been used for musculoskeletal pain. The development of acetyl salicylic acid was a major breakthrough in joint pain management. This was followed by the introduction of nonsteroidal anti-inflammatory agents, paracetamol, and the use of corticosteroids. The gold-based compounds were the initial disease-modifying drugs and have been followed by the highly successful biologics agents. The basic objectives of musculoskeletal pain management include: reduction or elimination of joint pain; improvement or restoration of joint function and mobility; improvement of muscle strength to protect cartilage, ligaments, and joint capsule; prevention and reduction of damage to joint cartilage and supporting structures.

Genome-wide association study on pharmacological outcomes of musculoskeletal pain in UK Biobank.

The pharmacological management of musculoskeletal pain starts with NSAIDs, followed by weak or strong opioids until the pain is under control. However, the treatment outcome is usually unsatisfying due to inter-individual differences. To investigate the genetic component of treatment outcome differences, we performed a genome-wide association study (GWAS) in ~23,000 participants with musculoskeletal pain from the UK Biobank. NSAID vs. opioid users were compared as a reflection of the treatment outcome of NSAIDs. We identified one genome-wide significant hit in chromosome 4 (rs549224715, P = 3.88 × 10-8). Suggestive significant (P < 1 × 10-6) loci were functionally annotated to 18 target genes, including four genes linked to neuropathic pain processes or musculoskeletal development. Pathway and network analyses identified immunity-related processes and a (putative) central role of EGFR. However, this study should be viewed as a first step to elucidate the genetic background of musculoskeletal pain treatment.

Heat-stone massage for patients with chronic musculoskeletal pain: a protocol for multicenter randomized controlled trial.

Chronic musculoskeletal pain bothers the quality of life for approximately 1.71 billion people worldwide. Although pharmacological therapies play an important role in controlling chronic pain, overuse of opioids, persistent or recurrent symptoms, and pain-related disability burden still need to be addressed. Heat-stone massage is using the heated stone to stimulate muscles and ligaments followed by massage for relax, which can potentially treat the chronic musculoskeletal pain. To determine the efficacy and safety of heat-stone massage for patients with chronic musculoskeletal pain is needed. This multicenter, 2-arm, randomized, positive drug-controlled trial will include a total of 120 patients with chronic musculoskeletal pain. The intervention group will receive a 2 week heat-stone massage, 3 times per week, whereas the control group will receive the flurbiprofen plaster twice per day for 2 weeks. The primary end point is the change in Global Pain Scale from baseline to the end of the 2 week intervention. The secondary outcomes include the pain severity (Numerical Rating Scale), pain acceptance (Chronic Pain Acceptance Questionnaire), self-management (Health Education Impact Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (Short Form-36). The intention-to-treat dataset will be used for analysis. The pain management remains the research topic that patients always pay close attention to. This will be the first randomized clinical trial to evaluate whether heat-stone massage, a non-pharmacological therapy, is effective in the chronic musculoskeletal pain management. The results will provide evidence for new option of daily practice. World Health Organization Chinese Clinical Trial Registry [ChiCTR2200065654; https://www.chictr.org.cn/showproj.html?proj=185403]; International Traditional Medicine Clinical Trial Registry [ITMCTR2022000104; http://itmctr.ccebtcm.org.cn/en-US/Home/ProjectView?pid=51776b6f-77b8-4811-9b5a-a0fec10f2cee].