Musculoskeletal Pain Conditions Research Articles

Chronic Primary or Secondary Noninflammatory Musculoskeletal Pain and Disrupted Sexual Function and Relationships: A Systematic Review.

Evidence points to the impact of chronic musculoskeletal pain conditions on sexual function, yet there is little systematic appraisal and synthesis of evidence examining these associations across noninflammatory conditions. We aimed to systematically review evidence surrounding the association between chronic primary and chronic secondary musculoskeletal pain with intimate relationships and sexual function. Four electronic databases were searched from January 1, 1990 to September 5, 2019 for cross-sectional or prospective epidemiologic and qualitative studies among cohorts with chronic primary or secondary noninflammatory musculoskeletal pain, defined by International Classification of Diseases, Eleventh Revision classification criteria. Fifty-one eligible studies were included (46 quantitative, 3 qualitative, 2 mixed-methods designs). Sample sizes ranged from 13 to 12,377 and mean age from 32.6 to 69.2 years. Cross-sectional controlled cohort studies consistently reported poorer sexual function outcomes among cohorts with pain relative to comparison groups. Of 15 studies reporting outcomes for the Female Sexual Function Index, 14 demonstrated mean scores of ≤26.55 for the pain group, indicating sexual dysfunction. In 4 studies reporting the International Index of Erectile Function, the pain cohorts demonstrated consistently lower mean subscale scores and the erectile function subscale scores were ≤25.0, indicating erectile dysfunction. Three key themes emerged from a meta-synthesis of qualitative studies: impaired sexual function; compromised intimate relationships; and impacts of pain on sexual identity, body image, and self-worth. Sexual dysfunction and negative impacts on intimate relationships are highly prevalent among people with chronic noninflammatory musculoskeletal pain. Consideration of these associations is relevant to the delivery of holistic, person-centered musculoskeletal pain care.

EFFECT OF ULTRASOUND WITH ISOMETRIC EXERCISE VERSUS EFFECT OF ACUPUNCTURE WITH ISOMETRIC EXERCISE FOR THE NECK PAIN AMONGST THE COLLEGE STUDENTS. – A COMPARATIVE STUDY

Background: Neck pain is one of the most common and painful musculoskeletal conditions. For the majority of the neck disorders there is an absence of an identiable underlying disease or abnormal structure. The ultrasound improve blood ow and accelerate healing. The acupuncture treatment process is the insertion of needles at specic points into the body of patients. Isometric exercises are a type of strength training in which the joint angle and muscle length do not change during contraction. Aim And Objectives Aim: To compare the effectiveness of Ultrasound versus Acupuncture keeping Isometric exercises common for both for reducing the neck pain amongst the college students. Objectives: To nd the effectiveness of Ultrasound with Isometric exercises on neck pain amongst the college students. To nd the effectiveness of Acupuncture with Isometric exercises on neck pain amongst the college students. To nd the difference in the effectiveness of Ultrasound and Acupuncture, keeping isometric exercises common for both, on neck pain amongst the college students. Method:In a 3-week intervention study 30 participants divided into Group A (15) and Group B (15). Group A received Acupuncture with Isometric Exercise and Group B received Ultrasound with Isometric Exercise. Result: A signicant improvement in pain, (p‹0.05) after the treatment was found. Greater statistical signicant improvement was seen in Group B as compared to Group A. Conclusion: The study concluded that the treatment protocol received by Group B, Ultrasound with isometric exercise is more effective in reducing pain comparing to Group A who received Acupuncture with isometric exercise.

"I Don't Know Why I've Got this Pain!" Allostasis as a Possible Explanatory Model.

Awareness of the concept of allostatic load, and subsequent assessment of physical and psychological stressors potentially contributing to allostatic load, may facilitate a broader understanding of the multidimensional presentations of many people with pain, both acute and persistent. This may facilitate discussion between clinicians and their patients regarding broader influences on their presentations and drive more targeted and inclusive pain management strategies.

Carisoprodol Single and Multiple Dose PK-PD. Part II: Pharmacodynamics Evaluation Method for Central Muscle Relaxants. Double-Blind Placebo-Controlled Clinical Trial in Healthy Volunteers.

Centrally acting skeletal muscle relaxants (CMR) such as carisoprodol are used to treat acute, painful musculoskeletal conditions, though its precise mode of action has not been characterized. A double-blinded, placebo-controlled, randomized clinical trial was designed to evaluate the pharmacokinetics–pharmacodynamics (PKPD) of CMR after single (350 mg), double (700 mg), and multiple doses (up to 350 mg/8 h, 14 days) of carisoprodol. Muscular (Electromyogram–EMG, muscular strength dynamometry), central (sedation), and tolerability (psychomotor activity test, adverse events) parameters, as well as withdrawal symptoms, were evaluated. Thirteen healthy volunteers were enrolled. No evidence of direct muscle relaxation was evidenced, but some differences on sedation were evidenced throughout the study, suggesting that CMRs act, at least partly, through sedation. Most significant differences were detected at 1.5 h after dosing. The effect on psychomotor impairment was variable, most prominently after 1.5 h, too, suggesting that it is produced by carisoprodol rather than by meprobamate. No withdrawal symptoms were detected, so the risk of dependence following maximum doses and duration of treatment recommended, and under medical supervision, should be low.

The Usefulness of Serological Inflammatory Markers in Patients with Rotator Cuff Disease-A Systematic Review.

Background and Objectives: Rotator cuff disease (RCD) is a prominent musculoskeletal pain condition that spans a variety of pathologies. The etiology and precise diagnostic criteria of this condition remain unclear. The current practice of investigating the biochemical status of RCD is by conducting biopsy studies but their invasiveness is a major limitation. Recent biochemical studies on RCD demonstrate the potential application of serological tests for evaluating the disease which may benefit future clinical applications and research. This systematic review is to summarize the results of available studies on serological biochemical investigations in patients with RCD. Methods: An electronic search on databases PubMed and Virtual Health Library was conducted from inception to 1 September 2021. The inclusion criteria were case-control, cross-sectional, and cohort studies with serological biochemical investigations on humans with RCD. Methodological quality was assessed using the Study Quality Assessment Tool for Observational Cohort and Cross-sectional studies from the National Heart, Lung, and Blood Institute. Results: A total of 6008 records were found in the databases; of these, 163 full-text studies were checked for inclusion and exclusion criteria. Nine eligible studies involving 984 subjects with RCD emerged from this systematic review. The quality of the studies found ranged from poor to moderate. In summarizing all the studies, several fatty acids, nonprotein nitrogen, interleukin-1 β, interleukin-8, and vascular endothelial growth factor were found to be significantly higher in blood samples of patients with RCD than with control group patients, while Omega-3 Intex, vitamin B12, vitamin D, phosphorus, interleukin-10, and angiogenin were observed to be significantly lower. Conclusions: This is the first systematic review to summarize current serological studies in patients with RCD. Results of the studies reflect several systemic physiological changes in patients with RCD, which may prove helpful to better understand the complex pathology of RCD. In addition, the results also indicate the possibility of using serological tests in order to evaluate RCD; however, further longitudinal studies are required.

Interhemispheric Inhibition Between Primary Sensory Cortices is not Influenced by Acute Muscle Pain

Bilateral deficits in sensorimotor function have been observed in unilateral musculoskeletal pain conditions. Altered interhemispheric inhibition (IHI) between primary sensory cortices (S1s) is one mechanism that could explain this phenomenon. However, IHI between S1s in response to acute muscle pain, and the relationship between IHI and pressure pain sensitivity in the unaffected limb have not been examined. In 21 healthy individuals, IHI was assessed using somatosensory evoked potentials in response to paired median nerve electrical stimulation at: 1) baseline; 2) immediately following pain resolution; and 3) at 30-minutes follow-up. Acute muscle pain was induced by injection of hypertonic saline into the right abductor pollicis brevis (APB) muscle. Pressure pain thresholds were assessed at the right and left APB muscles before and 30-minutes after pain resolution. Compared to baseline, IHI from the affected to unaffected S1 was unaltered in response to acute muscle pain immediately following pain resolution, or at 30-minutes follow-up. Pressure pain thresholds were reduced over the right (P = .001) and left (P = .001) APB muscles at 30-minutes follow-up. These findings suggest IHI between S1s is unaffected by acute, short-lasting muscle pain, despite the development of increased sensitivity to pressure in the unaffected APB muscle. PerspectiveIHI from the affected S1 (contralateral to the side of pain) to unaffected S1 is unaltered following the resolution of acute muscle pain. This finding suggests that IHI between S1s may not be relevant in the development of bilateral sensorimotor symptoms in unilateral pain conditions.

Topikalni nesteroidni antiinflamatorni lekovi - koliko su značajni u lečenju mišićnoskeletnog bola

Topical nonsteroidal anti-inflammatory drugs are an effective and safe therapeutic option for the treatment of acute and chronic musculoskeletal disorders. Based on evidence from the literature, topical NSAID's have a clearly defined place in the treatment of acute musculoskeletal pain and in the treatment of osteoarthritis of the hands and knees. Due to the rare systemic side effects, they should always be advised as the first therapeutic line for the treatment of musculoskeletal pain in osteoarthritis of the hands and knees of patients ≥75 years of age. It is very important that there are no recommendations for the use of other topical preparations, such as rubefaciens and capsaicin for the treatment of painful musculoskeletal conditions. Clinical assessment of the patient, the condition of medical issue and the choice of the optimal NSAID's formulation, contribute to the success of the treatment. Gel formulations represent the optimal substrate for topical NSAID's both for best penetration and for best acceptance by patients. Gel formulations of topical NSAID's represent the optimal substrate for transdermal penetration and are best accepted by patients. They are also the optimal medium for sonophoresis, which is why they can be widely used in the field of physical medicine and rehabilitation.

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

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

“It's second best”: A mixed-methods evaluation of the experiences and attitudes of people with musculoskeletal pain towards physiotherapist delivered telehealth during the COVID-19 pandemic

BackgroundMusculoskeletal physiotherapy practice rapidly adopted telehealth during the COVID-19 pandemic, providing a unique opportunity to evaluate the experiences and attitudes of people who would not usually engage with these services. MethodsA sequential mixed-methods study recruited people with musculoskeletal pain conditions accessing Australian private practice physiotherapist services. Part 1 involved an online survey of telehealth services accessed, treatments and resources provided, self-reported global change in condition, and attitudes toward telehealth. Part 2 involved semi-structured interviews with a subset of survey participants, exploring experiences and attitudes towards telehealth. Quantitative data was reported descriptively. Qualitative data was evaluated using inductive thematic analysis. Results172 participants responded to the survey, and 19 were interviewed. 95% accessed video-based telehealth, and 85% reported condition improvement. 84% agreed it was an efficient use of their time, 75% agreed it was financially viable, and 73% agreed their condition was accurately diagnosed. 62% percent believed telehealth should be less expensive than in-person services. Qualitative analysis revealed four themes (17 subthemes), including (i) telehealth had value, but generally perceived as inferior to in-person care; (ii) challenges related to assessment, diagnosis, ‘hands on’ treatment, observation, communication, and technology; (iii) advantages to access safe, expert, and convenient care; and (iv) importance of supportive technology, including video and supplementary resources. ConclusionPhysiotherapist telehealth services provided to people with musculoskeletal pain during the pandemic was valued. However, telehealth was generally perceived as inferior to traditional in-person care, and may be best used as part of a hybrid model of care.

Central adverse drug reactions of NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) is a group of drugs used for analgesia, antinflammatory, antipyretical properties, and antiplatelet effects. NSAIDs are widely used in the treatment of osteoarthritis, musculoskeletal pain, gout and other pathological conditions, however, their use is associated with the risk of developing adverse drug reactions, including serious and fatal ones, for example, gastrointestinal bleeding, or myocardial infarction and stroke. Many NSAIDs can also cross the blood-brain barrier and cause central adverse drug reactions that can be mistaken by practical health care professionals for the manifestation of a new pathologies or insufficient effectiveness of treatment of an existing disease, but not with the use of NSAIDs, that may lead to errors in treatment tactics, additional prescription of drugs and an increased risk of complications. The purpose of this article is to inform practical health care professionals about the potential risks of central adverse drug reactions (including psychiatric ones) of NSAIDs, and thus, to increase the effectiveness and safety of therapy.

Demand-specific work ability among employees with migraine or frequent headache

Headache disorders have serious implications for employees’ work ability (WA). However, there is inadequate knowledge of what specific work-related activities that are affected by headache. We investigated demand-specific WA among individuals with migraine or frequent headache. We used cross-sectional questionnaire-data (n = 5,551) containing information about “migraine or frequent headache” and difficulties handling seven different job demands. In subgroup analyses (n = 4,028), we added information on medication. In ordinal logistic regression, we adjusted for sex, age, education, depressive symptoms and musculoskeletal pain. Individuals with previous or current migraine/headache had poorer WA, particularly with respect to the ability of handling physical and cognitive job demands. No use of medication as well as overuse of medication—both signalling suboptimal treatment—might aggravate the difficulties complying with job demands. Additionally, depressive symptoms and musculoskeletal pain seem to play a major role for the level of disability. Employees with headache disorders need adequate diagnosis and treatment. Rehabilitation should also address mental health as well as concurrent (musculoskeletal) pain conditions, which potentially benefit from non-medical interventions. Adjustment of the working conditions (physical and cognitive job demands) is likely to improve the work ability in this group of employees.

Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic Review of Indications, Safety, and Efficacy

ObjectiveThe study objective was to evaluate the safety and efficacy of transcatheter arterial “embolization” (TAE) in the treatment of chronic “musculoskeletal pain” refractory to standard therapy.MethodsPubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched for original research articles evaluating TAE in patients with musculoskeletal conditions from database inception to January 21, 2020. Search terms employed were as follows: “embolization”, “pain”, “knee osteoarthritis”, joint replacement, epicondylitis, tenderness, inflammation, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), microspheres, Embozene, geniculate artery, neovascularity, transcatheter, embolic, imipenem/cilastatin sodium, angiogenesis, and “musculoskeletal”. Studies involving particle “embolization” for painful musculoskeletal conditions were included. Studies of TAE for hemarthrosis or malignancy‐related “musculoskeletal pain” were excluded.ResultsThe primary search yielded 1,099 sources; 7 articles and 4 abstracts were included for data extraction. All were cohorts or case series, with low risk of bias and moderate to poor level of evidence. Heterogeneity between studies was high, precluding meta‐analysis. The reviewed studies reported the safety and efficacy of TAE for the treatment of “knee osteoarthritis”; adhesive capsulitis of the shoulder; tendinopathy/enthesopathy of the knee, shoulder, elbow, and ankle; and cervical myalgia. All TAEs were reported as technically successful without major complications or subsequent serious adverse events, including no reported osteonecrosis, cutaneous ulceration, limb ischemia, cartilage degeneration, or myotendinous injury. TAE significantly reduced pain and improved function for all of the treated conditions, with durable response up to 24 months post procedure.ConclusionTAE appears to be a safe and effective treatment for some types of chronic refractory “musculoskeletal pain”. Randomized placebo‐controlled studies are necessary to confirm these findings.

Effectiveness of Walk Standing Backbend Arch or Modified Anuvittasana in Patients with Si Joint Dysfunction: Experimental Study

Background – Sacroiliac joint dysfunction is a painful musculoskeletal condition, responsible for 15-30% cases of low back pain, also called as Sacroiliac syndrome. It is a term often used to describe pain in and around the region of the joint that is due to traumatic, infection, inflammatory, degenerative, metabolic and biomechanical disorders of the joint (hypermobility and hypo mobility) and pathological conditions. Methodology – The Study design is Experimental. Total 25 samples are selected conveniently for this study. Data was collected by using Pain perception on VAS (Visual Analog Scale) and Disability Score on Revised Oswestry Disability Index Results – It has been proved significant that there is average improvement of 16.48 in ODI and 5.04 in VAS. The result of experimenting the effectiveness of walk standing position back bend arch or modified Anuvittasana among 25 individuals with SI joint dysfunction is proved significantly effective on the patients who has undergone the treatment for 7 sessions of 7 day. Conclusion - It can be concluded from the present study that there is significant improvement in the pain, range of motion, activities of daily living that underwent walk standing position back bend arch or modified Anuvittasana exercise

The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain

ABSTRACT The preferences a person has for care are associated with outcomes for patients presenting with musculoskeletal pain conditions. These include preferences for differing levels of involvement in the decision-making process, preferences for the provider attributes, and preferences for particular interventions. In this paper, we discuss these various forms of preference, as well as how they influence clinical care within shared decision-making frameworks. We also present a conceptual framing for how patient preferences can be incorporated in clinical decision-making by orthopedic manual physical therapists. Finally, research implications for interpreting findings from clinical studies are discussed.

111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?

Abstract Aim The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects. Method We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020. Results No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality. Conclusions There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.

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

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

Musculoskeletal orofacial pains - overlap between tension type headache and temporomandibular disorder

A number of pain conditions in the head share clinical presentations such as being dull, diffuse, pressing, bilateral and longer-lasting with moderate intensity, often with pain referrals to the neck-shoulder regions, higher prevalence in women before menopause, aggravated by oral functions and stress and associated with considerable psycho-social distress and reduced quality of life. The International Classification of Headache Disorders (ICHD) have well-established criteria for tension-type headache and Headaches attributed to Temporomandbular Disorders (HA-TMD). The Diagnostic Criteria for TMD has set the standards for operationalized, reliable and valid diagnosis of myalgia and myofascial pain related to the jaw muscles and a variant of the HA-TMD diagnosis. Recently also International Classification for Orofacial Pain (ICOP) has proposed subtyping of the muscle pain conditions based on temporal characteristics: acute, infrequent, frequent and chronic occurrence. Nevertheless, the overarching question should be to what extent may underlying pathophysiology vary between these entities and what would the therapeutic implications be? The talk will attempt to review the musculoskeletal orofacial pain conditions, present new findings about the potential overlap and further phenotyping, and critically discuss the clinical ramifications.

215 Emergency Department Acupuncture for Acute Musculoskeletal Pain Management

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

Preventing progression from chronic to widespread pain and its impact on health-related quality of life: a historical cohort study of osteopathic medical care.

It is generally acknowledged that osteopathic physicians take a holistic approach to patient care. This style may help prevent the progression of painful musculoskeletal conditions, particularly if combined with osteopathic manipulative treatment (OMT). The study aimed to determine if osteopathic medical care lowers the risk of progression from localized chronic low back pain to widespread pain and lessens the impact of pain on health-related quality of life. A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data acquired from April 2016 through March 2021. Registry participants aged 21-79 years with chronic low back pain at the baseline encounter were potentially eligible for inclusion if they had a treating physician, completed all four quarterly follow-up encounters, and did not report physician crossover at the final 12-month encounter. Eligible participants were classified according to the type of physician provider at baseline and thereby into osteopathic or allopathic medical care groups. Participants were also classified according to prior use of OMT at the final encounter. Widespread pain was measured at baseline and each quarterly encounter to determine the period prevalence rate of widespread pain and its severity over 12months using the Minimum Dataset for Chronic Low Back Pain recommended by the National Institutes of Health. Participants who reported "not being bothered at all" by widespread pain during each encounter were classified as not having widespread pain, whereas those who were bothered "a little" or "a lot" at any quarterly encounter were classified as having widespread pain. The severity of widespread pain was measured by summing participant responses at each encounter. The Patient-Reported Outcomes Measurement Information System was used at each encounter to measure health-related quality-of-life (HRQOL) scores for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. A total of 462 participants were studied, including 101 (21.9%) in the osteopathic medical care group and 73 (15.8%) who used OMT. The mean age of participants at baseline was 52.7±13.2 years (range, 22-79 years) and 336 (72.7%) were female. A lower period prevalence rate of widespread pain was observed in the osteopathic medical care group (OR, 0.47; 95% CI, 0.27-0.81; p=0.006) and in the OMT group (OR, 0.40; 95% CI, 0.21-0.75; p=0.004), although the latter finding did not persist after adjustment for potential confounders. The osteopathic medical care and OMT groups both reported lower widespread pain severity. The osteopathic medical care group also reported better age- and sex-adjusted outcomes for each of the seven HRQOL dimensions throughout the study. The OMT group reported better outcomes in five of the HRQOL dimensions. This study supports the view that osteopathic physicians practice a holistic approach to medical care that manifests itself through a lower risk of progression from chronic low back pain to widespread pain, lower widespread pain severity, and lesser deficits in HRQOL. Similar findings were generally associated with OMT use.

Effects of weekly pain monitoring on back pain outcomes: a non-randomised controlled study

BackgroundDisease monitoring is an important element of self-management of several chronic diseases. Pain monitoring has become very easily available, but the role in musculoskeletal pain conditions is not clear. Awareness of pain might be helpful for people to understand pain, but focusing on pain may on the contrary negatively affect pain experience and behaviours. The objective of this study was to investigate the potential impact of pain monitoring on low back pain (LBP), specifically to determine if pain intensity, activity limitation and pain control, differed between patients with weekly pain monitoring over 12 months and patients with follow-ups at 2 weeks, 3 months and 12 months.MethodsThis was a non-randomised controlled study embedded in a cohort study with data collection November 1st 2016 to December 21st 2018. Adults seeking care for LBP were enrolled at the first visit to a chiropractor and followed with surveys after 2 weeks, 3 months and 12 months. Those enrolled first, n = 1,623, furthermore received weekly SMS-questions about pain frequency and pain intensity, whereas those enrolled next was the control group, n = 1,269 followed only by surveys. Outcomes at 12-months were compared, adjusting for group differences on baseline parameters.ResultsLBP intensity (0–10) was slightly lower at 12-months follow-up in the SMS group than the control group (adjusted beta − 0.40 (95% CI: − 0.62; − 0.19)). No relevant between-group differences were observed for activity limitation (0–100) (1.51 (95% CI: − 0.83; 3.85)) or ability to control pain (0–10) (− 0.08 (95% CI − 0.31; 0.15)).ConclusionsFrequent pain monitoring did not demonstrate any negative effects of weekly pain monitoring, and it was perhaps even helpful. The role of self-monitoring as part of self-managing LBP should be explored further including optimal frequencies, formats, and methods for feedback.Trial registrationThe study was not registered as a clinical trial.