Musculoskeletal Disorders Research Articles

Association of Self-Reported Improvement After 4 Weeks and Outcomes After 52 Weeks Among Adolescents With Patellofemoral Pain and Osgood-Schlatter Disease.

Short-term, self-reported changes in symptom severity for musculoskeletal pain disorders may be more strongly associated with long-term prognoses than baseline patient characteristics, because such changes describe a trajectory and not a state. To investigate whether short-term improvement in self-reported symptom severity is associated with long-term recovery among adolescents with nontraumatic knee pain (patellofemoral pain [PFP] or Osgood-Schlatter disease [OSD]). Cohort study; Level of evidence, 3. The authors evaluated data from 2 prospective clinical trials that included adolescents aged 10 to 14 years with either PFP (n = 151) or OSD (n = 51). Both groups underwent a self-management rehabilitation program including activity modification, education, and exercise. The primary outcome was a 7-point global rating of change (GROC) scale (from "much improved" to "much worse"); participants were considered to have improved symptoms if they reported being "much improved" or "improved." Outcomes were collected after 4 and 52 weeks. To investigate whether participants who improved according to GROC scores after 4 weeks were more likely to improve after 52 weeks compared with those who had not improved after 4 weeks, the authors calculated the relative risk (RR) of being improved. Among participants with PFP, reporting an improvement after 4 weeks increased the likelihood of an improvement after 52 weeks (RR = 1.26; 95% CI, 1.06-1.50; P = .008); among those with OSD, reporting an improvement after 4 weeks did not increase the likelihood of an improvement after 52 weeks (RR = 1.06; 95% CI, 0.88-1.28; P = .545). Among participants with PFP who did not improve after 4 weeks, 73% reported improvement after 52 weeks, whereas among participants with OSD who did not improve after 4 weeks, 89% reported improvement after 52 weeks. Self-reported improvement after 4 weeks of treatment was associated with better outcomes after 52 weeks among adolescents with PFP. This association was present only among adolescents with PFP, as almost all adolescents with OSD improved after 52 weeks, regardless of short-term results. Importantly, even among adolescents reporting no improvement after 4 weeks, a large proportion reported improvement after 52 weeks. This highlights the importance of following the rehabilitation program regardless of the short-term response.

A Real-World Study on Adverse Reactions of Belimumab Based on the FDA Adverse Event Reporting System Database.

This investigation leverages data derived from the United States Food and Drug Administration Adverse Event Reporting (FAERS) to real-world adverse reactions associated with Belimumab, with the intention of providing guidance for safe clinical pharmacotherapy. Data encompassing adverse drug event (ADE) reports relating to Belimumab from Q1 2011 to Q4 2023 within the FAERS were extracted and analyzed using methodologies such as the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS). The study identified a total of 19 825 ADE reports where Belimumab was the primary suspect medication, with the United States constituting the majority of reporting countries (16 312 cases, or 82.28%). Patients aged 18 to 64.9 years accounted for the largest demographic (36.29%), while the proportion of female patients (77.91%) significantly surpassed that of male patients (5.03%). The analysis uncovered 184 unique Preferred Terms (PTs) across 21 System Organ Classes (SOCs). Following selection through ROR, the SOC signal strength was prioritized as follows: Systemic disorders and administration site conditions, infections and infestations, a variety of musculoskeletal and connective tissue disorders, and conditions related to pregnancy, puerperium, and the perinatal period. The top five PTs for ADE reports not included in the product's labeling were hypersensitivity reactions, immunosuppression, non-vascular diseases, herpes virus infections, and Sjögren's syndrome. The top five PTs for ADE signal strength not included in the labeling were disseminated cutaneous herpes zoster, herpes zoster meningitis, onycholysis, cyclothymic disorder, and mixed connective tissue disease. Based on pharmacovigilance research utilizing the FAERS database, it is recommended that clinical monitoring of Bevacizumab should be intensified to support effective pharmaceutical care and ensure rational clinical medication use.

B-cell and plasma cell activation in a mouse model of chronic muscle pain

Fibromyalgia (FM) is a complex chronic musculoskeletal pain disorder with an elusive pathogenesis, with a strong implication of immune interactions. We recently found that IL-5 and the adaptive immune system mediates pain outcomes in fibromyalgia (FM) patients and preclinical models of FM-like chronic widespread pain (CWP). However, there is an active debate if FM/CWP has an autoimmune etiology. Preclinical models of CWP utilize a repeated insult paradigm, which resembles a primary, then secondary response similarly observed in the antibody response in which the subsequent event causes a potentiated pain response. Recent translational studies have implicated immunoglobulins (Ig) and B-cells in FM/CWP pathophysiology. To understand if these are involved in preclinical models of CWP, we performed comprehensive B-cell phenotyping in the bone marrow, circulation, and popliteal (draining) lymph nodes in the two-hit acidic saline model of CWP. We found increased MHC class II-expressing B-cells in peripheral blood, increased activated plasma cells in peripheral blood, and increased memory B-cells in the bone marrow. Interestingly, acidic pH (4.0) injected mice have reduced levels of IgG1, independent of treatment with IL-5. We have demonstrated that the acidic saline model of CWP induces T-cell mediated activation of B-cells, increased active plasma cells, and increased memory B-cells in female mice.

The Clinical Implications of Transdermal Baclofen in the Management of Mild-Moderate Neuropathic Pain

The pharmacotherapeutic management of chronic pain is a particular challenge for healthcare providers, as patients often require multimodal analgesia and polypharmacy in order to achieve symptomatic relief. Patient adherence, frequent dose titration, patient comorbidities, and individual characteristics can further complicate treatment and limit treatment options at the outpatient level. The therapeutic potential of localized analgesia in the treatment of chronic pain is of particular interest to healthcare providers nationwide, as it provides a necessary alternative to systemic analgesia. Compounding Pharmacies and FDA Outsourcing Facilities aid in this endeavor through endogenous compounding and manufacturing (respectively) of externally-applied pain formulations. This review summarizes the available clinical evidence supporting transdermal baclofen utilization in the symptomatic management of chronic musculoskeletal and/or neuropathic pain. The adjunctive treatment of pain from a localized perspective remains under-investigated, and the role of transdermal analgesics/antispasmodics in chronic pain management remains uncertain.

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

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

The Emergent Role of Low-Dose Naltrexone in the Symptomatic Management of Chronic Musculoskeletal and Neuropathic Pain

As a result of the intricate mechanisms of pain transmission, traditional analgesics used alone, as well as concomitantly, often do not provide consistent and/or adequate pain relief for patients suffering with chronic pain conditions. Many analgesics, as well as antineuropathic and antispastic drugs, demonstrate synergistic CNS side effects, increasing the risk of respiratory depression and overdose when used in combination. Given the steady rise of opioid-related overdose deaths in the USA, pursuit of novel treatment options, such as low dose naltrexone (LDN) regimens, are of particular interest to researchers. Although multiple reliable studies exist which demonstrate the potential for LDN in pain management, large-scale, high-quality studies are lacking, or are in progress. This review article aims to analyze the currently available literature regarding low dose naltrexone therapy in order to evaluate its potential role in the management of chronic inflammatory, neuropathic, and generalized pain symptoms. Although promising, available data is limited in its utility, warranting further research and development regarding the clinical role and place in therapy of LDN in chronic pain management.

Effects of Conventional versus Virtual Reality-simulated Treadmill Exercise on Fatigue, Cognitive Function, and Participant Satisfaction in Post-COVID-19 Subjects. A Randomized Trial

Background/ObjectivePost-COVID-19 subjects typically experience symptoms of fatigue, cognitive impairment, and sleep difficulty, which can be relieved by conventional aerobic exercise. Virtual Reality (VR) technology to support conventional exercise has recently gained much attention. Therefore, this study aimed to assess the effects of traditional treadmill exercise compared to virtual reality-simulated treadmill exercise on fatigue, cognitive function, sleep quality, and participant satisfaction with the exercise program in post-COVID-19 subjects. MethodsThis single-centered, randomized, parallel-group intervention study was conducted between December 2021 and March 2022. Sixteen of twenty post-COVID-19 subjects completed this study (n1=8, n2=8). Inclusion criteria were persistent dyspnea/fatigue, mild cognitive problems, and age 30–60 years. Exclusion criteria were previous severe COVID-19 infection and ICU admission, concomitant respiratory or cardiovascular disease, and musculoskeletal or neurological disease. Eligible subjects were assigned randomly to two groups: a non-VR group that received traditional treadmill aerobic exercise only and a VR group that received treadmill exercise with non-immersive VR. Both groups received moderate-intensity exercise on a treadmill at [50–60% (peak HR－resting HR) + resting HR] for 30–45 min, three times per week, and for four weeks. The outcome measures were the Chalder Fatigue Scale, Montreal Cognitive Assessment (MoCA) questionnaire, Pittsburgh Sleep Quality Index (PSQI), and participant satisfaction with the exercise program rated on a 5-point Likert scale. ResultsBoth groups showed significant improvements in the Chalder Fatigue Scale, the MoCA questionnaire, and the PSQI scores after training compared to baseline (p<0.05), without significant differences between them (p>0.05). However, participant satisfaction with the exercise program was significantly higher in the VR group than in the non-VR group (p=0.037). ConclusionA moderate-intensity 4-week treadmill exercise program with and without non-immersive VR may improve fatigue, cognitive function, and sleep quality to the same extent in COVID-19 survivors. However, participant satisfaction with the exercise program could be greater after conventional treadmill training assisted by non-immersive VR than after conventional treadmill training alone in this cohort. Trial registrationPan African Clinical Trials Registry, PACTR202311561948428, retrospectively registered

Achilles tendinopathy treatment via circadian rhythm regulation

IntroductionAchilles tendinopathy (AT) is a prevalent musculoskeletal disorder closely linked to oxidative stress. Existing evidence suggests a potential link between circadian clock rhythms and oxidative stress. However, the precise role of the circadian clock in the progression and treatment of AT remains unclear. ObjectiveThe purpose of this study was to investigate the role of the Achilles tendon circadian clock in AT pathology and explore the potential use of biomaterials for modulating the circadian clock in the treatment of AT. MethodsWe utilized in vivo and in vitro models to investigate the alterations of the circadian clock within the Achilles tendon during the progression of AT, as well as its impact on disease development. Additionally, we fabricated Nb2C@CeO2 composites featuring a Schottky heterojunction for regulating the circadian rhythm and validated its therapeutic efficacy and molecular mechanism of AT through both in vivo and in vitro experiments. ResultsThe Achilles tendon functioned as a peripheral oscillator with an independent and self-sustained time-keeping system. The rhythm of the Achilles tendon clock was disrupted during the development of AT, as indicated by the decreased amplitude of Bmal1 and Nrf2 rhythm expression. Mechanistically, the knockdown of Bmal1 disrupted the Achilles tendon clock, thereby destroying the Bmal1-Nrf2 axis dependent molecular defense mechanism, and exacerbating the inflammatory response, whereas overexpression of Bmal1 had a protective effect. Nb2C@CeO2 composites with Schottky heterojunctions enhance intercellular electrical signaling, boosting Bmal1 expression and mitigating AT’s pathological changes. Importantly, enhancing Bmal1 expression during its peak, rather than its trough, was more effective. ConclusionThis study identified the protective role of the circadian clock against oxidative stress and inflammation in the Achilles tendon. Achilles tendon circadian clock-targeted therapy represents a promising strategy for AT treatment.

An Empirical and Deep Learning Investigation of Working Conditions and Musculoskeletal Outcomes in Wheat Farmers

Background: In developing countries, various farming activities are performed manually with the help of traditional hand tools. Therefore, agriculture is recognized as one of the risky occupations Objective: This research study aims to identify the critical working conditions of wheat farmers in Rajasthan state, India. Method: Data were collected through the survey conducted on 75 randomly selected wheat farmers of Rajasthan. The survey questionnaire gathered information related to demographic, occupational, and musculoskeletal discomfort faced by the farmers. In addition, a deep learning-based posture detection study of the workers was performed to assess the postural risks through a rapid upper limb assessment score. Result: The collected data were analyzed further for fruitful insights. The survey outcomes showed that awkward posture (41%) and repetitive movement (35%) were the most reported reasons for the severe risks of musculoskeletal disorders among farmers. The posture evaluationbased study outcomes showed that approximately 51% of subjects lie in the action category 4, which shows the higher level of risks in the activities performed by farmers. Conclusion: It is suggested to apply the principles of physical ergonomics in the agriculture sector and spread awareness among the farmers about the agriculture risks associated with farming activities.

Effectiveness of resistance training of masticatory muscles for patients with temporomandibular disorders: protocol for a systematic review

IntroductionTemporomandibular disorders (TMDs) are musculoskeletal disorders characterised by jaw pain and typically temporomandibular joint limitations. Resistance training (RT) has been shown to be effective at reducing pain and improving function...

Emerging roles of osteocytes in regulation of bone and skeletal muscle mass.

Contrary to the popular perception that the bone is merely a structural organ, decades of research have established its functional importance in whole-body metabolism. Osteocytes, which comprise >80% of all bone cells, were also initially thought to be terminally differentiated dormant cells lacking metabolic functions. However, new research is increasingly providing evidence that osteocytes not only play a role in the structural integrity of the bone, but also have secretory functions which regulate other bone cells as well as other organs including skeletal muscle - the structural-mechanical neighbor of the bone - via paracrine, and endocrine pathways. However, the publicly available preclinical and clinical data pertaining to the factors secreted by osteocytes and their functions in the musculoskeletal system largely fail to reach a consensus. This review is thus aimed to objectively collate all information available in the public domain for efficient access by researchers in the field. We strongly believe that this review will help researchers in an unbiased design of therapeutic strategies for musculoskeletal disorders.

Efficacy of a single dose of cryopreserved human umbilical cord mesenchymal stromal cells for the treatment of knee osteoarthritis:a randomized, controlled, double-blind pilot study

BackgroundKnee osteoarthritis (OA) is the most prevalent degenerative musculoskeletal disorder, which is particularly common in older population. While conventional treatments have limited effectiveness, the development of more effective therapeutic strategies is necessary to address this primary source of pain and disability. Umbilical cord mesenchymal stromal cells (UC-MSCs) offer a promising therapeutic approach for treating knee OA. AimThis randomized, prospective, double-blind and controlled pilot study was carried out to evaluate and compare the safety and therapeutic efficacy of a single intra-articular injection of a standardized product CellistemOA (5 × 106 ± 5 × 105 UC-MSCs), vs. triamcinolone (a synthetic corticosteroid) (10 mg/mL) in thirty patients with symptomatic knee OA (Kellgren–Lawrence grade II or III). MethodsThe outcomes included changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores based on a Likert scale, numerical rating score (NRS) for pain, Magnetic Resonance Imaging (MRI), and quality of life (SF-36 questionnaire), from baseline and throughout 12-months of follow-up. ResultsPatients treated with CellistemOA showed significant improvement in WOMAC score (including the three subscale scores (pain, stiffness and function), NRS in pain, and SF-36 profile from baseline to 12 months (p < 0.05) compared to the triamcinolone group, and no severe adverse events were reported. There were no significant differences in MRI WORMS scores between the two groups. However, patients who received the cellular treatment experienced a significant improvement in their SF-36 profile (p < 0.05). ConclusionsThis pilot study revealed that a single dose of CellistemOA is safe and superior to the active comparator in knee OA at 1-year of follow-up, making it a compelling therapeutic alternative to treat symptomatic OA patients.

Comparing repeated end range movements and Kinesio taping effects on head and neck movement pattern and discomfort in smartphone users

IntroductionUsing smartphones has increased exponentially, especially after the COVID-19 pandemic. However, there is a relationship between neck flexion angle during working with a smartphone and neck musculoskeletal disorders. Therefore, this study compares the effect of Kinesio taping and Repeated End Range Movements (RERM) on head and neck flexion angles changes during texting and discomfort after texting with a smartphone. MethodTwenty-four smartphone users participated in this cross-over study. All of 24 subjects were experimented with the control, RERM and taping conditions. They filled Numeric Rating Scale questionnaire before and after 30 min of texting. In addition, their head and neck flexion angles were measured during the task by photogrammetry. ResultsIn the RERM group, individuals felt significantly less discomfort than the control group after the task (P = 0.032). Although the slope of average head and neck flexion angles linear regression lines of all the three groups was positive before the break time, it became negative in the taping and control groups after the break time. In addition, the linear regression of average head and neck flexion angles of the RERM group was significantly different (P < 0.001). ConclusionRERM can effectively maintain normal head and neck movement pattern during and reduce neck discomfort after texting on smartphone.

Influence of medial longitudinal arch flexibility on lower limb joint coupling coordination and gait impulse

BackgroundA causal link exists between structural differences in the foot and alterations in the lower limb biomechanics, which might predispose an individual to develop characteristic musculoskeletal disorders. Research questionThis study aimed to determine how the foot structural characteristics, as represented by the medial longitudinal arch flexibility, affect lower limb joint coupling coordination and anterior-posterior ground reaction impulses (GRIs) during walking and running. MethodsFollowing the calculation of arch height flexibility, a total of fifty-four physically active males were grouped and completed gait experiments to collect kinematic and kinetic data synchronously. Inter-joint coordination and variability were calculated from the angle-angle plots of knee-hip, ankle-knee, and metatarsophalangeal (MTP)-ankle couplings based on an optimized vector coding technique. ResultsOur results indicate that coupling coordination of interest and its variability, as well as anterior-posterior GRIs, could potentially be influenced due to differences in arch height flexibility. Notably, the individuals with stiff arches exhibited significantly greater coordination variabilities during the early stance for both ankle-knee and MTP-ankle coordination yet significantly smaller for MTP-ankle coordination variabilities during the mid-stance phase. Furthermore, combining the statistical parametric mapping analysis results, the flexible arches experienced a greater proportion of GRIs in the anterior-posterior direction. SignificanceIn conclusion, these observations demonstrated that variations in arch flexibility led to differences in lower limb joint coordination variabilities and GRIs during gait. This fresh insight into inter-joint coordinative function may be useful for enhancing foot motion strategies based on arch structural characteristics.

Technology supported High Intensity Training in chronic non-specific low back pain (the Techno-HIT trial): study protocol of a randomised controlled trial

Chronic low back pain (CLBP) is one of the most common chronic musculoskeletal disorders worldwide. Guidelines recommend exercise therapy (ET) in CLBP management, but more research is needed to investigate...

Electromyographic analysis of bilateral upper trapezius muscles at different levels of work-pace among sewing machine operators

Workers are driven to work faster in the industrial work environment to meet high productivity targets. An increased work pace leads to increased muscle activation. However, the effect of work pace on bilateral upper trapezius muscles during sewing machine operation in an industrial work environment has not been thoroughly investigated in experimental studies. Therefore, this research aims to conduct an experimental study to analyze the bilateral upper trapezius muscle activity of industrial sewing machine operators at different levels of work pace. Thirty subjects (15 males, and 15 females) continuously performed the sewing operation for two hours in an industrial work environment. Experiments were conducted for two levels of work pace i.e. low pace (100% of standard cycle time) and high pace (120% of standard cycle time). Electromyographic signals were recorded from the bilateral upper trapezius muscles. The EMG amplitude (RMS) among the muscles was computed. A statistically significant (p < 0.05) increase in muscle activity was observed with an increased work pace. In this study, right upper trapezius muscle activity increased by 30.4% during high work pace tasks compared to low pace, while the left upper trapezius showed a 24.12% increase. The right upper trapezius showed a mean difference of 0.696 (%MVC), and the left upper trapezius showed 0.399 (%MVC), both indicating greater activity during high-pace tasks. The increase in muscle activity with time indicated the presence of muscle fatigue among sewing machine operators. Furthermore, higher muscular activity was observed among females than males. This research highlights the critical need to balance productivity goals with the health and safety of workers, reducing the risk of muscle fatigue and associated work-related musculoskeletal disorders.

Bilateral hand dystonia following high-velocity thrust manipulation: a case report.

Thrust manipulation is one of the most commonly used techniques for managing musculoskeletal pain in clinical practice. This involves the application of a high-velocity, low-amplitude force directed to the joints with the intent of achieving joint cavitation. This current case report describes a female in her mid-20s who presented with excessive bilateral and involuntary hand muscle contractions after bilateral thrust manipulation. Dystonia appeared both at rest and during voluntary movements but was aggravated by actions such as finger flexion or spreading and disappeared during sleep. A diagnosis of complex regional pain syndrome (CRPS) type I combined with dystonia was made. Prednisolone administered between 2 and 5 weeks after symptom onset significantly reduced CRPS symptoms, but intramuscular botulinum toxin injection 5 weeks after symptom onset was ineffective at controlling her symptoms. Seven weeks after symptom onset, the patient was administered 2 mg trihexyphenidyl oral twice a day, 2.5 mg diazepam oral twice a day and 5 mg baclofen oral three times a day for 1 month and this significantly reduced dystonia, but complete resolution was not achieved. Clinicians should be aware that dystonia is a rare complication of thrust manipulation.

Pain Self-Management in Individuals With Chronic Musculoskeletal Pain During Lebanon's Overlapping Crises

ObjectivesWith Lebanon facing multiple crises simultaneously, it is important to understand how Lebanese adults with chronic musculoskeletal pain (CMP) are self-managing their pain amidst challenging circumstances. This study aimed to describe the pain self-management strategies Lebanese adults with CMP are using, as measured by the Arthritis Pain Self-Management Inventory (APSI), and to determine how helpful they perceive these strategies to be for pain relief. A secondary aim was to translate, culturally adapt, and validate the APSI in Lebanese adults with CMP. MethodsA descriptive design was used and a convenience sample of 154 Lebanese adults with CMP completed the Arabic version of the APSI and self-report measures of pain intensity and sociodemographic and clinical characteristics. ResultsThe APSI demonstrated acceptable content and cultural validity in Lebanese adults with CMP. Self-directed arthritis education was the strategy used by the largest number of participants, although it was perceived as the second least helpful for pain relief. The second and third most common strategies used were rest/relaxation, warm baths, and maintaining a healthy weight. The most helpful strategy was maintaining a healthy weight, followed by watching religious television, music therapy, and the use of braces or splints. ConclusionsLebanese adults with CMP should actively participate in their pain management plan and be educated on the various strategies they could use to effectively self-manage their pain.

Improving NSAID Safety: The Role of Transdermal Ketoprofen in the Management of Musculoskeletal Pain and Inflammation

Pain and inflammation affect patients both acutely and chronically across all patient demographics. Often, the medications which are used to target musculoskeletal conditions are poorly tolerated due to various contraindications, drug interactions, and troublesome adverse events. The investigation and development of localized, externally applied NSAIDs is on the rise among researchers and pharmaceutical manufacturers, but research is still inefficient in determining the role in therapy of transdermal analgesics and anti-inflammatories. Compounding Pharmacies and FDA 503b Outsourcing Facilities aid in this critical endeavor through endogenous compounding and manufacturing (respectively) of transdermal analgesic formulations. This review summarizes the currently available data supporting the implementation of transdermal ketoprofen preparations in the management of musculoskeletal pain and inflammation. Externally applied NSAIDs are crucial in the development of pain management modalities which reduce the risk of numerous complications, including drug-drug interactions, conflicting comorbidities, and harmful systemic adverse events.

A Survey of Pain and Musculoskeletal Dysfunction Prevalence After Gender-Confirming Surgery of the Urogenital System

Purpose: We sought to (1) explore the prevalence of pain, and movement and urogenital dysfunction reported following gender confirming vaginoplasty (V) and phalloplasty (P), (2) identify which providers were consulted for pain, and movement and urogenital dysfunction after surgery, and (3) compare these factors between people receiving V and P surgeries. Methods: A custom internet survey, built in REDCap, was distributed through LGBTQIA+ organizations across the US. The survey collected demographic information, types of surgery, postsurgical impairments (pain and urogenital dysfunction), and activity limitations, along with the types of providers seen and interventions provided. Summary statics were calculated and proportions or means and standard deviations based on the data structure. Nonparametric measures were used to test associations between postsurgical care, gender identity, and geographic location. Results: 584 responses remained after data cleaning of which 89 people reported having vaginoplasty (V) and 118 had phalloplasty (P). The average age of respondents was 28.6 ± 5.2 years. 70% of respondents reported pain, 25% difficulty moving, 23% bowel or bladder dysfunction, and 9% dyspareunia. Significantly more respondents who had V reported dyspareunia, while more respondents who had P reported incontinence. 20%, 29%, 15%, and 13% of included respondents received care from a physical therapist for pain, difficulty moving, incontinence, and dyspareunia, respectively. Discussion: These results indicate that both individuals who undergo V or P procedures report musculoskeletal pain, movement problems, and pelvic floor dysfunction following GCS. Notably, these issues are commonly addressed in cisgender patients by physical rehabilitation providers. However, less than half of our sample were referred to a physical therapist.