Musculoskeletal Pain Patients Research Articles

Understanding the epidemiology and perceived efficacy of cannabis use in patients with chronic musculoskeletal pain

BackgroundThe belief that cannabis has analgesic and anti-inflammatory properties continues to attract patients with chronic musculoskeletal (MSK) pain towards its use. However, the role that cannabis will play in the management of chronic MSK pain remains to be determined. This study examined 1) the rate, patterns of use, and self-reported efficacy of cannabis use among patients with chronic MSK pain and 2) the interest and potential barriers to cannabis use among patients with chronic MSK pain not currently using cannabis.MethodsSelf-reported cannabis use and perceived efficacy were prospectively collected from chronic MSK pain patients presenting to the Orthopaedic Clinic at the University Health Network, Toronto, Canada. The primary dependent variable was current or past use of cannabis to manage chronic MSK pain; bivariate and multivariable logistic regression were used to identify patient characteristics independently associated with this outcome. Secondary outcomes were summarized descriptively, including self-perceived efficacy among cannabis users, and interest as well as barriers to cannabis use among cannabis non-users.ResultsThe sample included 629 patients presenting with chronic MSK pain (mean age: 56±15.7 years; 56% female). Overall, 144 (23%) reported past or present cannabis use to manage their MSK pain, with 63.7% perceiving cannabis as very or somewhat effective and 26.6% considering it as slightly effective. The strongest predictor of cannabis use in this study population was a history of recreational cannabis use (OR 12.7, p<0.001). Among cannabis non-users (N=489), 65% expressed interest in using cannabis to manage their chronic MSK pain, but common barriers to use included lack of knowledge regarding access, use and evidence, and stigma.ConclusionsOne in five patients presenting to an orthopaedic surgeon with chronic MSK pain are using or have used cannabis with the specific intent to manage their pain, and most report it to be effective. Among non-users, two-thirds reported an interest in using cannabis to manage their MSK pain, but common barriers to use existed. Future double-blind placebo-controlled trials are required to understand if this reported efficacy is accurate, and what role, if any, cannabis may play in the management of chronic MSK pain.

Early Outcomes of Orthopedic Pre-surgical Patients Enrolled in an Intensive, Interprofessional Lifestyle Medicine Program to Optimize Health

Recently, lifestyle medicine (LSM) application has shown feasibility for musculoskeletal pain patients with co-existing lifestyle-related chronic diseases. This study describes early results of a LSM program for musculoskeletal patients with goals to optimize health prior to orthopedic surgery. Fifty-four patients (age: 61 ± 11 years; 39 [72%] females) completed the program from 3/8/22-12/1/23. Data included patient goals, utilization, goal attainment, and patient outcomes. Most patients (41/54 [76%]) enrolled with established surgical dates. Mean BMI was 43.2 ± 5.3 kg/m2, and 89% had ≥2 lifestyle-related chronic diseases. The majority reported impaired sleep (79%) and zero cumulative minutes of physical activity/week (57%). Mean program duration was 13 ± 8 weeks involving 5 ± 4 visits with members of the interprofessional team. Fifty-two (96%) patients successfully attained pre-program goals, and 49/54 (91%) met their surgical goal. Of the patients enrolled without surgical dates, 11/13 (85%) optimized their health and proceeded to surgery. Forty-two (78%) patients reported decreases in weight and BMI, averaging 11 ± 7 lbs and 1.8 ± 1.3 kg/m2, respectively. Rates of improvement in pain, PROMIS-10 physical and mental health, and PHQ-4 were 52%, 37%, 45%, and 47%, respectively. These data demonstrate the feasibility and effectiveness of a LSM program to address whole-person health optimization and enable orthopedic patients to improve lifestyle behaviors and proceed to orthopedic surgery.

Association between Sleep Quality and Musculoskeletal Pain in Patients with Osteoarthritis

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease that significantly impacts quality of life, primarily through pain and disability. Existing research indicates a strong correlation between sleep quality and pain management in OA patients, suggesting that sleep may play a crucial role in modulating perceived pain and overall well-being. Objective: The objective of this study was to investigate the association between sleep quality and musculoskeletal pain in patients diagnosed with osteoarthritis, aiming to identify potential therapeutic targets for improving patient outcomes. Methods: This cross-sectional study was conducted at the University of Lahore teaching hospital, Jinnah Hospital. After obtaining approval from the hospital's ethics committee and informed consent from participants, data was collected using the Numeric Pain Rating Scale (NPRS) and Pittsburgh Sleep Quality Index (PSQI) from 170 diagnosed osteoarthritis patients of varying ages (18-40 years). The data were statistically analyzed using SPSS version 25, employing descriptive statistics for demographic data, and chi-square tests to explore the association between sleep quality and pain levels. Results: The mean age of the study participants was 28.74 (SD = 7.001). Among the participants, 15.3% reported no pain, 10.6% mild pain, 41.2% moderate pain, and 32.9% severe pain. Regarding sleep quality, 35.3% of patients reported good sleep, whereas 64.7% experienced poor sleep. The chi-square analysis indicated a significant association between pain levels and sleep quality (p &lt; 0.05). Conclusion: The study demonstrated a significant relationship between sleep quality and the severity of musculoskeletal pain among osteoarthritis patients. These findings suggest that interventions aimed at improving sleep may enhance pain management and thus the overall health status of OA patients.

Prevalence of Musculoskeletal Pain in Patients Following Cardiac Surgery in Peshawar: A Cross Sectional Study

Background: Cardiovascular diseases causes more deaths and disability in developing countries than any other disease in the world, for these diseases, CABG (Coronary artery bypass grafting) and VR (valvular replacement) are the best treatment options, although, these surgeries improve the chances of survival but they may cause chronic post operative musculoskeletal pain. Musculoskeletal pain can arise from different body musculoskeletal structures such as muscles, tendons, ligaments and joints and knowing the exact cause of this musculoskeletal pain is very difficult and challenging. Chronic musculoskeletal pain patients may have different signs of pain and spread of pain to degrees which are related to pain intensity and duration, so in management, it is very important to reduce duration and intensity of pain. Methods: A cross-sectional survey design was conducted among 199 cardiac patients in Peshawar from both genders, from June 2018-November 2018 among patients at RMI, KTH.,LRH and at other private clinics. Tool used for data collection named as Orebro musculoskeletal pain questionnaire and self- made questionnaire was used in this study. Results: Patients mean age was 53.49±11.88, 69.8% were males and 30.2% were females. The results showed that most common MSK pain site is upper back 27.6% and most common surgery is CABG. This study analyzed that different surgical procedure through which participants had been undergone. The surgical procedures were categorized into 4 main domains as shown in table 8 and frequency analysis was done which shows that most common surgical procedure is CABG (Coronary artery bypass grafting) 64.3%. The result of this study shows that diagnosis domain descriptive analysis was done to find out the frequency of the present pain conditions of the participants which exhibits that most common pain occurs in the back 27.6% and in the shoulder 25.1% Conclusion: Results among patients of Peshawar showed that most common surgery performed is CABG while PCI intervention is the next. Most of the patients are suffered from upper back pain while leg pain and cervical pain is not so common.

Self-reported urinary urgency in association with vitamin D and psychiatric symptoms among patients with musculoskeletal pain.

Urinary urgency (UU) is linked to musculoskeletal pain (MSP), and it is associated with mental health conditions. This study examined the prevalence of UU morbidity among outpatients with MSP, and the possible association of UU with psychological symptoms and vitamin D deficiency. A cross-sectional study was conducted among 169 participants recruited from outpatient clinics at King Abdullah University Hospital in Jordan. Participants completed self-guided questionnaires that included information about MSP and UU. Psychological symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS). A blood sample was collected for measuring vitamin D levels. Regression analysis was performed to explore predictors of MSP and UU. Vitamin D deficiency was presented in 64.5% of participants, while UU was reported among 35.4% of MSP patients. Approximately 1/3 of participants had psychiatric symptoms (HADS≥8). Regression analyses revealed a significant association between vitamin D deficiency, low calcium intake, and anxiety scores with MSP (p<0.05), while anxiety score was a significant predictor of UU among MSP patients (adjusted OR=4.26, p=0.038). A moderately significant correlation between anxiety score and frequency of UU per day was also observed (r=0.303, p=0.041). Urinary urgency was prevalent among MSP patients and was strongly associated with anxiety symptoms. The findings suggest the importance of assessment of MSP patients for UU and the associated psychological symptoms so interventions may be potentially implemented to improve patients' health conditions.

Cost‑Effectiveness Analysis of Tapentadol PR Versus Oxycodone/Naloxone PR in Patients with Musculoskeletal Pain in Spain

Objetive: Chronic musculoskeletal pain is highly prevalent worldwide and is associated with a huge social and economic burden. Opioids are commonly prescribed to treat chronic pain as recommended by the European Pain Federation. Tapentadol prolonged release (PR), is a strong opioid that has proven being effective in treating chronic musculoskeletal pain with less adverse events than oxycodone/naloxone PR. The aim of this study was to estimate the cost-effectiveness of tapentadol PR compared to oxycodone/naloxone PR from the Spanish National Healthcare System perspective (SNHS). Methods: A Markov model was adapted analysing two arms: patients treated with tapentadol PR and patients treated with oxycodone/naloxone PR. The model assesses a cohort of 1,000 patients over a one-year period. Results: Overall, treating patients with tapentadol PR was less costly than treating patients with oxycodone/naloxone PR (€388,631.70 vs €568,168.85). In terms of cost effectiveness, the incremental cost of tapentadol PR over oxycodone/naloxone PR was -€179,537.15 and the incremental quality-adjusted life year value was 40.05. The incremental cost-effectiveness ratio was estimated at -€4,027.16 per quality-adjusted life year suggesting that tapentadol PR is an economically dominant alternative over oxycodone/naloxone PR. Conclusion: Tapentadol PR represents a cost-effective option to treat musculoskeletal chronic pain patients in Spain. Keywords: Musculoskeletal pain, Opioids, Tapentadol PR, Cost effectiveness, Spain.

Factors affecting the intensity of chronic musculoskeletal pain in patients with cardiovascular disease and evaluation of the efficacy of magnesium emulsion cream for muscle cramps.

Chronic musculoskeletal pain (CMP) is associated with an increased risk of cardiovascular disease (CVD). This study aimed to determine the factors associated with the intensity of CMP in patients with underlying CVD and to evaluate the efficacy of Ice Power Magnesium In Strong Cream in patients with muscle cramps. We investigated 396 patients with or without CMP who visited an outpatient cardiology clinic and analyzed the features of CMP and factors associated with pain intensity and specific types of CVD in study 1. We also analyzed 73 patients who had muscle cramps in the lower extremities in study 2 to evaluate the efficacy of Ice Power Magnesium In Strong Cream in reducing pain intensity. In study 1, multivariable linear regression analysis showed that older age (regression coefficient [B] = 0.66, 95% confidence interval [CI], 0.07-1.24), female sex (B = 1.18, 95% CI, 0.59-1.76), presence of hypertension (B = 0.69, 95% CI, 0.05-1.33), and use of calcium supplements (B = 1.27, 95% CI, 0.31-2.24) were significantly associated with a higher intensity of CMP. In study 2, the mean pain scores at baseline, week 2 and week 4 after treatment were 5.99 ± 2.12, 2.92 ± 2.63, and 1.90 ± 2.41, respectively, and the reductions were significant at both week 2 and week 4 after treatment (P < .05). Older age, female sex, hypertension, and use of calcium supplements were associated with an increased intensity of CMP. Ice Power Magnesium In Strong Cream was effective in reducing the pain intensity of muscle cramps in the lower extremities.

Prediction of musculoskeletal pain after the first intravenous zoledronic acid injection in patients with primary osteoporosis: development and evaluation of a new nomogram

ObjectiveTo construct a new prediction nomogram to predict the risk of musculoskeletal pain in patients with primary osteoporosis who receive zoledronic acid intravenously for the first time.MethodClinical data of 368 patients with primary osteoporosis who received the first intravenous injection of zoledronic acid in our hospital from December 2019 to December 2022 were studied. Patients were divided into a musculoskeletal pain group (n = 258) and a non-musculoskeletal pain group (n = 110) based on the presence or absence of musculoskeletal pain 3 days after injection. Statistically significant predictors were screened by logistic regression analysis and the minimum absolute contraction and selection operator (LASSO) to construct a nomogram. The nomogram was evaluated by the receiver operating characteristic (ROC) curve, the calibration curve, the C-index, and the decision curve analysis (DCA) and verified in a validation cohort.ResultsThe independent predictors of the nomogram were age, serum 25-hydroxyvitamin D, NSAIDs, prior Vitamin D intake, and BMI. The area under the ROC curve (AUC) was 0.980 (95% CI, 0.915–0.987), showing excellent predictive performance. The nomogram c index was 0.980, and the nomogram c index for internal verification remained high at 0.979. Moreover, calibration curves show that the nomogram has good consistency. Finally, the DCA showed that the net benefit of the nomogram was 0.20–0.49.ConclusionMusculoskeletal pain is a common symptom of APR in OP patients treated with intravenous zoledronic acid. Risk factors for musculoskeletal pain after zoledronic acid injection in OP patients were: non-use of NSAIDs, youth (<80 years old), serum 25 (OH) D<30ng /mL, no prior intake of vitamin D, BMI<24 kg /m2. A nomogram constructed from the above predictors can be used to predict musculoskeletal pain after the first zoledronic acid injection.

Estimating the direct healthcare utilization and cost of musculoskeletal pain among people with comorbidity: a retrospective electronic health record study

Objective To investigate the impact of pre-existing painful musculoskeletal conditions on healthcare utilization and costs among patients with five common conditions: acute coronary syndrome (ACS), stroke, cancer, dementia and pneumonia. Methods Using primary and secondary care services data from electronic health records, a negative binomial regression model was used to compare resource use while a two-part model was used to compare costs across the five conditions, between those with and without a pre-existing musculoskeletal pain. Results The study included 760,792 patients (144,870 with ACS, 121,208 with stroke, 231,702 with cancer, 134,638 with dementia, and 128,374 with pneumonia) in the complete case analysis. Pre-existing musculoskeletal pain had an incident rate ratio of above one for most healthcare resources over the follow-up period and an adjusted additional mean cumulative total healthcare costs per patient of £674.59 (95%CI 570.30 to 778.87) for ACS; £613.34 (95%CI 496.87 to 729.82) for stroke; £459.26 (95%CI 376.60 to 541.91) for cancer; and £766.23 (95%CI 655.06 to 877.39) for dementia over five years after diagnosis; and £200.85 (95%CI 104.16 to 297.55) for pneumonia over one year after diagnosis compared to those without musculoskeletal pain. Conclusion This study highlights that individuals with painful musculoskeletal conditions have higher healthcare utiliszation and costs than those without painful musculoskeletal conditions. Given the high occurrence of musculoskeletal pain in patients with other conditions, effective management strategies are needed to reduce the burden on healthcare resources.

Effect of research participation versus usual clinical care in patients with rheumatic and musculoskeletal disorders: a prospective cohort study

ObjectiveTo compare illness perception (IP), pain, functional level and health-related quality of life (HR-QoL) between patients with musculoskeletal pain who participate versus those who do not participate in clinical research...

Virtual Reality-Based Exercise Therapy for Patients with Chronic Musculoskeletal Pain: A Scoping Review.

This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the studies to assess eligibility, with a third author resolving any discrepancies. Data were extracted and summarized in a narrative format by three independent raters. Clinical trials were evaluated using the PEDro scale to assess the effectiveness of virtual-reality-based exercise therapy in chronic musculoskeletal pain patients. A total of 162 articles were identified from the databases. After applying the inclusion criteria, nine articles were considered suitable for analysis, including six randomized clinical trials. The selected articles were categorized based on study characteristics, virtual-reality-based exercise therapy interventions (including technologies and equipment used), exercise interventions, outcome measures, and effectiveness. The findings indicate that virtual-reality-based exercise therapy shows promising results in reducing pain, improving disability, enhancing range of motion, and increasing treatment satisfaction in patients with chronic musculoskeletal pain. However, it is not possible to conclude that virtual-reality-based exercise therapy is superior to other treatments due to the limited number of available studies, heterogeneity in application protocols, and varying methodological quality. Further research is needed to draw more definitive conclusions.

Decreased expression of hyaluronan synthase and loss of hyaluronan-rich cells in the anterior tibial fascia of the rat model of chemotherapy-induced peripheral neuropathy.

Previous studies on chemotherapy-induced peripheral neuropathy (CIPN) have focused on neuronal damage. Although some studies have revealed that the fascia is an important sensory organ, currently, we do not know about chemotherapy drug-induced fascial dysfunction. This study aimed to explore the fascia as a nonneural cause of mechanical hypersensitivity in CIPN by investigating the expression of hyaluronic acid synthase (HAS) and histology of the fascia in an animal model of CIPN. Rats were intraperitoneally administered with vincristine (VCR). Mechanical hypersensitivities of the hind paw and the anterior tibial muscle were assessed. The expression of HAS mRNA in the fascia of the anterior tibial muscles was quantitated using reverse transcription polymerase chain reaction. Immunohistochemistry was also performed for HAS2, hyaluronic acid-binding protein, and S100A4 in the fascia. Vincristine administration significantly decreased mechanical withdrawal thresholds in the hind paw and the anterior tibial muscle after day 3. Quantitative polymerase chain reaction showed significant downregulation of HAS mRNAs in the fascia of VCR-treated rats. Immunohistochemical analysis showed that the number of cells with strong HAS2 immunoreactivity, classified as fasciacytes by morphology and colocalized marker S100A4, decreased significantly in the VCR group. Hyaluronic acid plays a critical role in somatic pain sensation. Damaged fascia could be a possible cause of musculoskeletal pain in patients with CIPN. This study suggests that fascia is a nonneural cause and novel therapeutic target for chemotherapy-induced "peripheral neuropathy."

Preference of musculoskeletal pain treatment in middle-aged and elderly chinese people: a machine learning analysis of the China health and retirement longitudinal study

BackgroundMusculoskeletal pain is a major cause of physical disability, associated with huge socioeconomic burden. Patient preference for treatment is an important factor contributing to the choice of treatment strategies. However, effective measurements for evaluating the ongoing management of musculoskeletal pain are lacking. To help improve clinical decision making, it’s important to estimate the current state of musculoskeletal pain management and analyze the contribution of patient treatment preference.MethodsA nationally representative sample for the Chinese population was derived from the China Health and Retirement Longitudinal Study (CHARLS). Information on the patients’ demographic characteristics, socioeconomic status, other health-related behavior, as well as history on musculoskeletal pain and treatment data were obtained. The data was used to estimate the status of musculoskeletal pain treatment in China in the year 2018. Univariate analysis and multivariate analysis were used to find the effect factors of treatment preference. XGBoost model and Shapley Additive exPlanations (SHAP) method were performed to analyze the contribution of each variable to different treatment preferences.ResultsAmong 18,814 respondents, 10,346 respondents suffered from musculoskeletal pain. Approximately 50% of musculoskeletal pain patients preferred modern medicine, while about 20% chose traditional Chinese medicine and another 15% chose acupuncture or massage therapy. Differing preferences for musculoskeletal pain treatment was related to the respondents’ gender, age, place of residence, education level, insurance status, and health-related behavior such as smoking and drinking. Compared with upper or lower limb pain, neck pain and lower back pain were more likely to make respondents choose massage therapy (P < 0.05). A greater number of pain sites was associated with an increasing preference for respondents to seek medical care for musculoskeletal pain (P < 0.05), while different pain sites did not affect treatment preference.ConclusionFactors including gender, age, socioeconomic status, and health-related behavior may have potential effects on people’ s choice of treatment for musculoskeletal pain. The information derived from this study may be useful for helping to inform clinical decisions for orthopedic surgeons when devising treatment strategies for musculoskeletal pain.

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

BackgroundAs with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question – do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain?ObjectiveTo compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom).MethodsA cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS.ResultsA total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen’s d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms).ConclusionFibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.

Predicting persisting disability in musculoskeletal pain patients with the STarT MSK screening tool: Results from aprospective cohort study.

The STarT MSK screening tool aims to categorise musculoskeletal patients into three risk groups for treatment stratification. The tool has been translated and validated into Hebrew. However, its ability to predict persistent disability in patients has yet to be evaluated. The primary aim of this study was to assess the ability of the Hebrew version of the STarT MSK tool to predict persistent disability in patients experiencing musculoskeletal pain. A prospective observational cohort study was conducted, recruiting 135 patients with musculoskeletal pain in five common areas: back, neck, shoulder, knee, or multisite pain over the age of 21. At the first consultation, all patients completed demographic information, the Focus On Therapeutic Outcomes (FOTO) questionnaire (function, pain, and fear avoidance score), and the STarT MSK questionnaire. The patients completed the FOTO questionnaire again at the end of the physiotherapy treatments. 25 patients (18.5%) were classified into the low-risk group, 68 patients (50.3%) into the medium-risk group, and 42 (31.1%) into the high-risk group. The baseline STarT MSK tool score demonstrated an excellent ability to identify patients at high risk of developing persistent disability (AUC=0.795, 95% CI 0.716-0.873). The Hebrew version of the STarT MSK tool can differentiate between three chronic risk groups and has high predictive validity for chronicity. This may provide a tool to assist clinicians in identifying patients who require more intensive care, and thus, potentially prevent the transition to chronic disabling pain.

Perception of Heaviness Induced by Sensorimotor Incongruence Is Associated with Pain Prognosis: A Pilot Study.

Patients with chronic musculoskeletal pain experience not only pain but also abnormal body perception. Such abnormal body perception has been reported to be caused by incongruence between motor intentions and sensory feedback (i.e., sensorimotor incongruence). However, the influence of abnormal body perception with sensorimotor incongruence on pain prognosis in musculoskeletal pain patients has not been investigated. We aimed at clarifying the influence of abnormal body perception on pain prognosis using an experimental procedure for inducing sensorimotor incongruence in patients with musculoskeletal pain. We recruited 18 patients within 2 months after limb fracture or ligament injury. In the experiment, patients sat with the intact upper or lower limb reflected in a large mirror aligned with the sagittal plane. A motor task was performed for 20 seconds in each of the congruent and incongruent conditions. In the congruent condition, patients were asked to perform flexion-extension movements with the intact and affected limbs in-phase, while observing the intact limb in the mirror. In the incongruent condition, patients were asked to perform flexion-extension movements antiphase, while observing the intact limb in the mirror. After performing the congruent and incongruent conditions, patients were asked to complete a questionnaire about abnormal body perception. These procedures were conducted within 2 months after the fracture (first), 2 weeks after the first measurement (second), and 4 weeks (third) after the first measurement. Pain, heaviness, and peculiarity were more likely to be experienced in incongruent conditions. Additionally, structural equation modeling indicated that heaviness at the first time point predicted the pain intensity at the second and third time points. Heaviness caused by sensorimotor incongruence may predict pain prognosis in patients with musculoskeletal pain after one month.

Emotion regulation mediates the relationship between family caregivers' pain-related beliefs and patients' coping strategies.

Background: In order to tailor more effective interventions and minimize the burden of chronic pain, it is critical to identify the interaction and contribution of social and psychological factors in pain. One of the important psychological factors in pain management is related to the choice of pain coping strategies in chronic pain patients. Social resources, including family caregivers' pain attitudes-beliefs, can influence pain coping strategies in chronic pain patients. Moreover, one key factor that may intervene in the relationship between caregivers' pain attitudes-beliefs and the patients' coping strategies is the emotion regulation strategies. Therefore, the present study aimed to investigate the mediating role of emotion regulation strategies of chronic pain patients and their family caregivers on the association between caregivers' pain attitudes-beliefs and pain coping strategies of chronic pain patients. Methods: We recruited 200 chronic musculoskeletal pain patients and their family caregivers. Chronic pain patients responded to measures of pain coping and emotion regulation strategies while family caregivers completed questionnaires related to their attitude toward pain and emotion regulation of themselves. Results: There is an association between caregivers' pain attitudes-beliefs and pain coping strategies in patients with chronic musculoskeletal. Moreover, the structural equation modeling revealed that the emotion regulation of both patients and family caregivers mediate the relationship between the caregivers' pain attitudes-beliefs and pain coping strategies of patients with chronic musculoskeletal. Conclusions: The social context of pain, including the effect of family caregivers' responses to the patient's pain, is a critical pain source that is suggested to affect coping strategies in patients. These findings suggest an association between pain attitudes-beliefs in family caregivers and pain coping strategies in patients. Moreover, these results showed that the emotion regulation of both patients and their family caregivers mediates this association.

Association of phase angle with sarcopenia in chronic musculoskeletal pain patients: a retrospective study

BackgroundIn chronic musculoskeletal pain patients, detection of sarcopenia is of significant clinical interest. Phase angle, which can be measured through bioelectrical impedance analysis (BIA), can detect sarcopenia; however, the evidence in chronic musculoskeletal pain patients is limited. This study aimed to assess the relationship between phase angle and sarcopenia in patients with chronic musculoskeletal pain. Our hypothesis was that phase angle would be a useful indicator to identify sarcopenia in patients with chronic musculoskeletal pain.MethodsA total of 190 patients (51 men and 139 women) with chronic musculoskeletal pain were included in this retrospective cross-sectional study. Patient data of backgrounds, numeric rating scale score for pain, skeletal muscle index, and phase angle assessed using BIA were retrospectively reviewed. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019.ResultsA total of 51 patients (26.7%), including 10 men (19.6%) and 41 women (29.5%), were diagnosed with sarcopenia. Phase angle, sarcopenia-related factors, age, and body mass index (BMI) differed significantly in patients with and without sarcopenia. On multiple logistic regression analysis, the prevalence of sarcopenia was significantly correlated with phase angle and BMI. The areas under the curve exhibited high accuracy in discriminating sarcopenia in men and moderate accuracy in both sexes and in women.ConclusionsPhase angle may be a valid discriminator of sarcopenia in patients with chronic musculoskeletal pain.

Effect of Different Physical Therapy Interventions on Brain-Derived Neurotrophic Factor Levels in Chronic Musculoskeletal Pain Patients: A Systematic Review.

The main objectives of this review were, firstly, to study the effect of different physiotherapy interventions on BDNF levels, and, secondly, to analyze the influence of physiotherapy on pain levels to subsequently draw conclusions about its possible relationship with BDNF. Based on the theory that neurotrophic factors such as BDNF play a fundamental role in the initiation and/or maintenance of hyperexcitability of central neurons in pain, it was hypothesized that the levels of this neurotrophic factor may be modified by the application of therapeutic interventions, favoring a reduction in pain intensity. A literature search of multiple electronic databases (Pubmed, PsycINFO, Medline (Ebsco), Scopus, WOS, Embase) was conducted to identify randomized control trials (RCTs) published without language restrictions up to and including March 2022. The search strategy was based on the combination of medical terms (Mesh) and keywords relating to the following concepts: "pain", "chronic pain", "brain derived neurotrophic factor", "BDNF", "physiotherapy", and "physical therapy". A total of seven papers were included. There were two studies that showed statistically significant differences in pain intensity reduction and an increase in the BDNF levels that used therapies such as rTMS and EIMS in patients with chronic myofascial pain. However, the same conclusions cannot be drawn for the other physical therapies applied. rTMS and EIMS interventions achieved greater short-term reductions in pain intensity and increased BDNF over other types of interventions in chronic myofascial pain patients, as demonstrated by a moderate amount of evidence. In contrast, other types of physical therapy (PT) interventions did not appear to be more effective in decreasing pain intensity and increasing BDNF levels than placebo PT or minimal intervention, as a low amount of evidence was found.

Asthenic post-COVID syndrome

To evaluate the efficacy and safety of combination therapy for post-COVID asthenic syndrome with multicomponent bioregulatory drugs Traumeel S, Ubichinon compositum and Coenzyme compositum. The study included 104 patients (averaged age 39.5 [30.8; 48] years) after COVID-19, clinically recovered from an acute infectious process, with asthenic syndrome lasting from 2 weeks to 6 months; the severity of asthenic syndrome on the asthenia VAS scale was at least 30 points. Before the start of the study, in addition to a physical examination, the patient's condition was assessed using the following questionnaires and scales: VAS for asthenia, subjective scale for assessing asthenia (MFI-20), L.D. Malkova, a questionnaire for the quality of life (EQ-5D), a questionnaire for identifying signs of autonomic disorders (Vayne A.M.). The patient's condition was monitored during follow-up visits 2 weeks, 1 month after the start of treatment and 1 month after the end of treatment. Patients of the main group received combination therapy, which included Traumeel S 1 tablet x 3 times a day, Ubichinone compositum and Coenzyme compositum 2.2 ml intramuscularly, alternating every other day, for 1 month (15 injections of each drug per course of treatment). Patients of the comparison group received eleutherococcus extract 100 mg during 30 days, 2 tablets x 2 times a day before mealsand vitamins B. The effectiveness of therapy was assessed by analysis of the asthenia severity (VAS scale), quality of life (EQ-5D questionnaire), patient satisfaction with treatment on a 5-point scale, which was carried out 1 month after the end of the course of treatment. As a result of the treatment was positive. The general asthenia severity, low activity and motivation significantly decreased in patients of both groups without significant differences. At the same time, in patients of the comparison group, there was no correlation between the quality of life and physical and mental asthenia, while in the main group there was an inverse correlation with the asthenia severity, which indicates an increase in the quality of life with a decrease in the severity of asthenia. One of the significant differences was the regression of headache and musculoskeletal pain in patients of the main group. The advantage of combined therapy of post-COVID asthenic syndrome with bioregulation therapy Traumeel S, Ubichinone compositum and Coenzyme compositum was shown in comparison with one of the common treatment regimens, including eleutherococcus extract and combined preparations of B vitamins.