Severe Musculoskeletal Pain Research Articles

The severity of the pathogen-induced acute sickness response is affected by polymorphisms in genes of the NLRP3 inflammasome pathway

The acute sickness response (ASR) is a stereotyped set of symptoms including fatigue, pain, and disturbed mood, which are present in most acute infections. The immunological mechanisms of the ASR are conserved, with variations in severity determined partly by the pathogen, but also by polymorphisms in host genes. The ASR was characterised in three different serologically-confirmed acute infections in Caucasians (n = 484) across four symptom domains or endophenotypes (termed ‘Fatigue’, ‘Musculoskeletal pain’, ‘Mood disturbance’, and ‘Acute sickness’). Correlations were sought with functional single nucleotide polymorphisms in the NLRP3 inflammasone pathway and severity of the endophenotypes. Individuals with severe Fatigue, Musculoskeletal pain, or Mood endophenotypes were more likely to have prior episodes of significant fatigue (11.4 vs. 3.8%, p = 0.07), pain (14.3 vs. 1.2%, p = 0.001), or Mood disturbance (13 vs 1%, p=0.001), suggesting trait characteristics. The high functioning allele of the rs35829419 SNP in NLRP3 was more common in those with severe Fatigue (OR = 13.3, 95% CI: 1.7–104), particularly in a dominant inheritance pattern (OR = 13.4, 95% CI: 1.8–586.3). In a multivariable analysis assuming dominant inheritance, both rs35829419 and the rs4848306 SNP in Interleukin(IL)-1β, were independently associated with severe Fatigue (OR = 29.6, 95% CI: 2.6–330.9 and OR = 13, 95% CI: 2.7–61.8, respectively). The severity of fatigue in acute infection is influenced by genetic polymorphisms in NLRP3 and IL-1β.

Hypophosphatasia: is it an underdiagnosed disease even by expert physicians?

Hypophosphatasia (HPP) is caused by mutations in the ALPL that encodes the tissue-nonspecific isoenzyme of alkaline phosphatase (ALP). Clinical manifestations range from extreme life-threatening lethal forms to no signs or symptoms at all. Consecutive 30,000 outpatients and inpatients with ALP data were screened retrospectively, out of which 1000 patients were found to have low levels of ALP more than once. Then, patients were evaluated for the symptoms and signs of HPP with further biochemical and genetic analyses. Thirty-seven patients who had severe musculoskeletal pain, recurrent fractures, and tooth anomalies were then screened with substrate and DNA sequencing analyses for HPP. It was determined that eight patients had variants in the ALPL gene. A total of eight different ALPL variants were identified in eight patients. The variants, namely c.244G > C (p.Gly82Arg), c.1444C > T (p.His482Tyr), c.1487A > G (p.Asn493Ser), and c.675_676insCA (p.Met226GlnfsTer52), had not been previously reported. Considering the wide spectrum of clinical signs and symptoms, HPP should be among the differential lists of bone, muscle, and tooth abnormalities at any age.

Effect of supplementation of vitamin D and calcium on patients suffering from chronic non-specific musculoskeletal pain: A pre-post study.

Background and Objective:Despite abundant sunshine, India is a country with high prevalence of vitamin D deficiency. It has been suggested that vitamin D deficiency could be a potential cause of chronic non-specific musculoskeletal pain. The study was conducted to evaluate the effect of supplementation of vitamin D and calcium on patients suffering with chronic non-specific musculoskeletal pain.Methodology:The experimental trial was a pre-post study conducted on 50 hypovitaminosis D patients aged 30–60 years visiting a local orthopedician or physician with complain of chronic non-specific musculoskeletal pain. Oral supplementation with vitamin D and calcium was given for 3 months. Before the intervention trial, pain, physical activity, serum vitamin D, serum calcium, body mass index and waist to hip ratio (WHR) of the respondents were assessed, which was statistically compared with post-intervention data of the same parameters. Assessment of pain was carried out using visual analog scale. Physical activity levels were compared pre and post the intervention. Also, fatigue, mood alteration, and sleep were compared.Results:Ninety percent of the subjects had vitamin D deficiency. Thirty-six percent of the subjects had severe chronic non-specific musculoskeletal pain, whereas 56% had moderate chronic non-specific musculoskeletal pain. The mean pain score prior to intervention was 6.22 which significantly decreased to 3.52. Mean vitamin D levels significantly rose from 17.38 ng/ml to 39.40 ng/ml. Serum vitamin D, serum calcium, and physical activity levels increased, whereas pain, weight, BMI, and WHR decreased significantly post-intervention.Conclusions:Supplementation with vitamin D and calcium decreases chronic non-specific musculoskeletal pain.

Marked motor function improvement in a 32-year-old woman with childhood-onset hypophosphatasia by asfotase alfa therapy: Evaluation based on standardized testing batteries used in Duchenne muscular dystrophy clinical trials

Hypophosphatasia (HPP) is a rare disorder resulting from biallelic loss-of-function variants or monoallelic dominant negative variants in the ALPL gene. We herein describe the clinical outcome of a 32-year-old woman with childhood-onset HPP caused by compound heterozygous variants in ALPL. Her chief complaints were severe musculoskeletal pain, muscle weakness, and impaired daily activities necessitating assistance in housework and child-rearing in addition to a history of early tooth loss and mildly short stature. Asfotase alfa therapy produced a remarkable increase in muscle strength and daily activities and markedly reduced musculoskeletal pain. Drug efficacy was clearly demonstrated through multiple test batteries (muscle strength test using microFET®2, six-minute walking test, Stair Climb Test, rising-from-floor-time test, and number-of-steps test using Actigraph®) currently adopted as standardized evaluations in Duchenne muscular dystrophy clinical trials since no test batteries for HPP have been established to date. These tests may also be promising for the assessment of HPP.

The Effects of a Pain Psychology and Neuroscience Self-Evaluation Internet Intervention: A Randomized Controlled Trial.

Many patients' chronic musculoskeletal pain is strongly influenced by central nervous system processes such as sensitization or amplification. Education about pain neuroscience can change patients' beliefs but has less consistent effects on pain outcomes. Patients may have greater clinical benefits if the educational intervention is personalized, and they evaluate various psychosocial risk factors with respect to their pain. We developed and tested a brief, internet-based Pain Psychology and Neuroscience (PPN) self-evaluation intervention. From a patient registry, 104 adults reporting chronic musculoskeletal pain were randomized to the PPN intervention or a matched, active, education control condition. At baseline and 1-month (primary endpoint) and 10-month follow-ups, participants reported pain severity (primary outcome) and multiple secondary outcomes. Primary analyses compared the 2 experimental conditions using analyses of covariances; post hoc exploratory analyses compared the effects of PPN in subgroups of patients who met criteria for fibromyalgia (FM; n=50) or who did not (n=54; primarily spinal pain). At 1-month follow-up, compared with the control condition, PPN led to significantly lower pain severity (ηp =0.05) and interference (ηp =0.04), greater brain (ηp =0.07) and psychological (ηp =0.07) attributions for pain, and greater readiness for pain self-management (ηp =0.08). Effects on distress, pain catastrophizing, kinesiophobia, and life satisfaction were not significant. Exploratory analyses showed that the PPN intervention was especially beneficial for patients without FM but was of less benefit for those with FM. Most of the effects (except attributions) were lost at 10 months. A brief PPN self-evaluation intervention, presented on-line, can yield short-term improvements in musculoskeletal pain severity and interference, especially for people with spinal/localized pain rather than FM, perhaps because the psychology/neuroscience perspective is more novel for such patients.

SAT-LB69 Severe Disabling Musculoskeletal Pain as a Side Effect of Bisphosphonates: A Case Report and Review of Literature

We report a case of a 57-year-old woman who developed severe musculoskeletal pain after taking one dose of Alendronate 70mg for treatment of osteoporosis. The pain was so debilitating that the patient was unable to sit up, stand, or move without assistance, and any kind of movement aggravated the pain.Key words: bisphosphonate, severe muscle pain, case report, osteoporosisMethodsA detailed case report is presented. A review of the current literature on the side effects of bisphosphonates was made for reference.ResultsDevelopment of severe, disabling musculoskeletal pain was noted after taking one dose of Alendronate 70 mg tablet. The pain was severe enough to hinder the patient from sitting or standing up, and any form of movement seemed to worsen the pain. Discontinuation of the drug, pain relievers and complete bed rest afforded slight relief of symptoms. Complete resolution of pain only occurred after 72 hours. Review of literature showed that muscle pain with intake of bisphosphonates occurred in a few patients, and were mostly found in case reports or case series. Other commonly associated side effects with bisphosphonate therapy were also briefly discussed.ConclusionThe case presented emphasizes that bisphosphonate therapy, although frequently used uneventfullyn, may still produce adverse effects in a few patients. A handful may present with severe debilitating muscle pain as seen in our patient. Literature review showed that another subset of patients may react differently and present with cardiac or ocular symptoms. What must be taken from this paper is the importance of patient education regarding these possible adverse events that although infrequent, may still happen. These unpleasant adverse effects may greatly affect compliance and ultimately have a bigger impact in the fight against osteoporosis.

Are weather conditions associated with chronic musculoskeletal pain? Review of results and methodologies.

Many people believe that weather influences chronic musculoskeletal pain. Previous studies on this association are narratively reviewed, with particular focus on comparing methodologies and summarising study findings in light of study quality. We searched 5 databases (Medline, Embase, Web of Science, PsycINFO, and Scopus) for observational studies on the association between weather variables and self-reported musculoskeletal pain severity. Of 4707 located articles, 43 were eligible for inclusion. The majority (67%) found some association between pain and a weather variable. Temperature, atmospheric pressure, relative humidity, and precipitation were most often investigated. For each weather variable, some studies found an association with pain (in either direction), and others did not. Most studies (86%) had a longitudinal study design, usually collecting outcome data for less than a month, from fewer than 100 participants. Most studies blinded participants to study aims but were at a high risk of misclassification of exposure and did not meet reporting requirements. Pain severity was most often self-reported (84%) on a numeric rating scale or visual analog scale. Weather data were collected from local weather stations, usually on the assumption that participants stayed in their home city. Analysis methods, preparation of weather data, and adjustment for covariates varied widely between studies. The association between weather and pain has been difficult to characterise. To obtain more clarity, future studies should address 3 main limitations of the previous literature: small sample sizes and short study durations, misclassification of exposure, and approach to statistical analysis (specifically, multiple comparisons and adjusting for covariates).

76-Year-Old Woman With Generalized Weakness

76-Year-Old Woman With Generalized Weakness

Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery.

To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life. The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS. Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.

BURDEN OF POTENTIALLY INAPPROPRIATE MEDICATIONS AMONG OLDER VETERANS WITH PAIN AND DEMENTIA

Among 115,869 Veterans ≥65 years old with a history of moderate to severe musculoskeletal pain (numerical pain intensity rating ≥4) admitted to Veterans Health Administration hospitals in fiscal year 2013, we tested whether medication use is potentially inappropriate (defined using the 2015 Beers Criteria; categorized as central nervous system (CNS) or other drugs) according to Alzheimer’s Disease and Related Dementias (ADRD) status based on ICD-9 codes. We used Poisson regression to estimate the association of the number of CNS Beers Criteria drugs (anticholinergics, antidepressants, antipsychotics, benzodiazepines, sedative hypnotics, pain medications, and opioids) and other Beers Criteria drugs according to ADRD status. The mean age of the cohort at the index hospital admission was 74.5 (SD 8.2), with 19.0% having ADRD and a Charlson comorbidity index of 3.9±3.0. After adjusting for age, sex, race/ethnicity, marital status, body mass index, 16 diagnostic criteria for pain and chronic conditions, mental health conditions and use of other system Beers Criteria drugs, we found that the mean number of CNS Beers Criteria drugs were 25% higher among Veterans with ADRD, with an adjusted risk ratio (aRR) of 1.25 (95% CI 1.23, 1.27; P <.0001). On the other hand, the mean number of other Beers Criteria drugs appeared to be 2% lower among ADRD group compared with inpatients without ADRD (aRR: 0.98 (95% CI: 0.97, 0.99), p<0.004). Clinicians need to be aware of potential side effects of using CNS Beers drugs in people with ADRD and whether there are alternatives to their use.

Tapentadol prolonged release in fragile geriatric patients > 70 years with chronic severe musculoskeletal pain: an open-label, prospective, observational study.

Chronic pain is highly prevalent in the elderly, and the prolonged use of long-term opioids for the management of chronic musculoskeletal pain is controversial. Tapentadol, combining μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition (NRI) in a unique mechanism of action, may be a valid option for chronic pain management in the geriatric population. The aim of the study was to assess the efficacy and tolerability of tapentadol prolonged release (PR), administered to patients aged ≥ 70 years with chronic pain. A total of 20 elderlies, naïve to opioids and with persistent moderate-to-severe chronic pain from different etiologies received tapentadol PR with up-titrations as necessary. The response to treatment, defined as at least 30% reduction in pain intensity compared with baseline, was the primary endpoint. Secondary endpoints were pain intensity on the Numeric Rating Scale (NRS) both at rest and during loading and sleep quality. Tapentadol PR was safe and effective in our population of elderlies with chronic pain from different etiologies: pain intensity compared with baseline, both at rest and during load, was statistically lower at each visit (p<0.01), whereas sleep quality improved significantly throughout the study (p<0.05). Only few minor side effects were reported, with an overall good safety profile and a very high tolerability and satisfaction for treatment. Tapentadol PR, adequately titrated according to patients' response in naïve subjects, is safe and effective to control pain in the elderly.

Musculoskeletal pain and its correlates among secondary school female teachers in Aljouf region, Saudi Arabia

Musculoskeletal pain is considered to be one of the most prevalent occupational health problems in the working environment. School teachers are at significant risk of developing this pain. The objective of this study is to assess musculoskeletal pain and its correlates among secondary school female teachers in Aljouf region, Saudi Arabia. A descriptive cross-sectional study was carried out on 254 secondary school female teachers in Aljouf region, Saudi Arabia. A structured, self-administered questionnaire was utilized in the present study to collect the required data. Data analysis was performed using the SPSS program, version 21. The prevalence of musculoskeletal pain among secondary school female teachers in Aljouf region, Saudi Arabia was 68.50%. The main sites of musculoskeletal pain were low back (68.4%), knee (58.6%), shoulder (47.7%), neck (45.4%), elbow (23.6%), and wrist (14.4%). Nearly 70% of the teachers had musculoskeletal pain in various sites. Days of absenteeism per month because of musculoskeletal pain were one to five days among 89.7% of the teachers. Regarding the severity of musculoskeletal pain, 64.4% had non-disabling pain and 35.6% had disabling pain. Factors that showed a significant relationship with disabling musculoskeletal pain were age (p = 0.013), marital status (p = 0.043), practicing exercise (p = 0.008), years of teaching (p = 0.020), daily hours of working (p = 0.039), number of classes per week (p = 0.013), and comfortableness of school furniture (p = 0.009). Logistic regression analysis showed that the significant predictors of disabling musculoskeletal pain were age more than 40 years [odds ratio (OR): 2.08; confidence interval (CI): 1.16–3.71], not practicing exercise (OR: 3.19; CI: 1.29–7.88), more than ten years of teaching (OR: 2.07; CI: 1.12–3.84), and non-comfortableness of school furniture (OR: 2.16; CI: 1.21–3.88). Secondary school female teachers showed a high prevalence of musculoskeletal pain in most anatomic sites, such as low back, knee, shoulder, neck, elbow, and wrist. Significant predictors of disabling musculoskeletal pain were age more than 40 years, not practicing exercise, more than ten years of teaching, and non-comfortableness of school furniture.

Polyarteritis nodosa (PAN) associated with familial Mediterranean fever (FMF): An unusual case presentation and a review of the literature

IntroductionPolyarteritis Nodosa (PAN) is a rare systemic necrotizing vasculitis and the variety in clinical presentations lead to difficulty in diagnosis. The co-incidence of PAN disease and familial Mediterranean fever (FMF) has been reported and as they share similar clinical symptoms such as fever, abdominal pain, arthralgia, and skin rash the diagnosis could be challenging. Case reportThis report is presented as one of the unusual cases of PAN with intra-parenchymal renal aneurysm rupture, which was misdiagnosed as peri-renal abscess in a patient with FMF. Case presentationA 24 year–old Syrian man presented to the Emergency Department of Tishreen Hospital with fever (39 °C), anorexia, general weakness, severe musculoskeletal pain, weight loss and flank tenderness. He had a history of FMF since he was 7 years old and used to be treated with colchicine. Laboratory investigations revealed leukocytosis, anaemia, increased erythrocyte sedimentation rate (99 mm/1st h) and C-reactive protein (CRP) (96 mg/l). Renal function, urine analysis, creatinine clearance, electrolytes and transaminases were normal. Urine and blood culture were negative. The anti-neutrophil cytoplasmic antibody, rheumatoid factor and hepatitis markers were negative. On abdominal ultrasonography, renal parenchyma was hyper-echogenic with surrounding liquid. Antibiotics were provided with no improvement. The patient developed secondary hypertension and MRI brain revealed ischemic cortical and subcortical parietal lesions. PAN was diagnosed based on renal CT angiography showing multiple micro-aneurysms. Consequently, methylprednisolone pulses and cyclophosphamide were introduced with dramatic improvement. ConclusionIncreased awareness of such clinical association of PAN and FMF and early management may improve the disease outcome.

Musculoskeletal Disorders Related to the Professional Work of Academic Teachers and the Quality of their Work

Abstract The organization of space and working conditions is very important in terms of its effectiveness. Each professional work determines activities that support occupational safety and health at the workplace. Lack of proper working conditions but also the time of exposure to dangerous, burdensome or harmful factors has an impact on the effectiveness of the work performed. Lack of balance between work and leisure in turn results in a decrease in work efficiency. The scientific and didactic work of academic teachers is related to the occurrence of diversified occupational hazards with particular emphasis on those that are the cause of musculoskeletal disorders. In this elaboration, the research, analysis and evaluation of the work effectiveness of academic teachers have been carried out. A questionnaire and a direct interview have been used as a research method. In addition, the pain intensity in individual parts of the body has been assessed in the last 12 months depending on the age of research and teaching staff using the NMQ questionnaire (Nordic Musculoskeletal Questionnaire). For the purposes of the study, the survey was supplemented with the VAS (Visual Analogue Scale) scale to assess the severity of pain. The purpose of the paper is to evaluate the frequency and severity of musculoskeletal pain in academic teachers with regard to the effectiveness of their work

The interplay between sleeplessness and high-sensitivity C-reactive protein on risk of chronic musculoskeletal pain: longitudinal data from the Tromsø Study.

To examine independent associations of sleeplessness and high-sensitivity C-reactive protein (hsCRP) with risk of chronic musculoskeletal pain, and to explore the joint effect of sleeplessness and hsCRP on risk of chronic musculoskeletal pain. A population-based prospective study of 3214 women and 3142 men (mean age: 55.4, range: 32-87) without severe chronic musculoskeletal pain and with hsCRP ≤ 10 mg/L at baseline in 2007-2008. Modified Poisson regression was used to calculate adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for any chronic musculoskeletal pain and chronic widespread pain (CWP) at follow-up in 2015-2016 associated with self-reported sleeplessness and hsCRP at baseline. Compared with persons without sleeplessness, women and men reporting often/or always sleeplessness had RRs of CWP of 2.53 (95% CI: 1.94-3.29) and 2.48 (95% CI: 1.63-3.77), respectively. There was no clear association between hsCRP and risk of any chronic musculoskeletal pain or CWP. Joint effect analyses using persons without sleeplessness and with a hsCRP < 1.00 mg/L as the reference gave RRs for chronic musculoskeletal pain of 1.73 (95% CI: 1.26-2.37) for those with often/always sleeplessness and hsCRP < 1.00 mg/L; 1.01 (95% CI: 0.78-1.32) for those without sleeplessness and hsCRP ≥3.00 mg/L; and 2.47 (95% CI: 1.79-3.40) if they had both often/always sleeplessness and hsCRP ≥ 3.00 mg/L. The corresponding RRs for CWP were 1.89 (95% CI: 1.27-2.83), 0.96 (95% CI: 0.68-1.37), and 2.83 (95% CI: 1.91-4.20), respectively. These results suggest that there is an interplay between sleeplessness and hsCRP on risk of any chronic musculoskeletal pain and CWP.

(183) Central Sensitization Inventory Discriminates between Pain Groups in Individuals with Inflammatory Bowel Disease

Abdominal and musculoskeletal (MSK) pain experiences are common in inflammatory bowel diseases (IBD). Recent evidence suggests that MSK pain severity is influenced by IBD activity and it is mediated by symptoms commonly related to central sensitization syndromes. However, it is not known whether severity of central sensitization symptoms can discriminate the type of pain presentation in individuals with IBD. A cross-sectional online survey among 305 New Zealand adults with IBD (aged 18-88 years) was conducted. Features of IBD, abdominal pain, and MSK pain were examined using multiple validated questionnaires. Presence and severity of symptoms commonly seen in central sensitivity syndromes were assessed using the central sensitization inventory (CSI). One-way analysis of variance with post-hoc multiple comparisons, while controlling for age and gender, was used to determine differences in CSI scores based on the type of pain presentation: no pain (n=61), only abdominal pain (n=36), only MSK pain (n=82), and both abdominal/MSK pain (n=125). Analysis indicated significantly different CSI scores between identified pain presentations (F (3,298) = 32.187, p ≤ .000). Individuals reporting no pain demonstrated the lowest CSI scores (M = 31.25, SD = 12.39), while those with both abdominal/MSK pain demonstrated the highest (M = 51.48, SD = 13.22). Post-hoc comparisons described significant differences (p ≤ .05) in CSI scores between all pain groups, except between individuals only reporting musculoskeletal pain and those only reporting abdominal pain (MD = 1.07, SE = 2.52). In the present study, CSI scores were able to discriminate pain presentations in IBD, with higher CSI scores in individuals with both abdominal/MSK pain. Future research should explore the relationship between CSI scores in this population with clinical measures of central sensitization.

(208) 17b-Estradiol as a Predictor and Potential Mediator of Chronic Musculoskeletal Pain Development in Women following Trauma Exposure

Chronic musculoskeletal pain (MSP) is common following traumatic or stressful life events and is more common in women than men. However, female specific predictors and mediators of chronic posttraumatic MSP are poorly understood. In the current study we examined the relationship between circulating 17β-estradiol (E2) levels, RNA transcripts that E2 might influence, and chronic MSP development in women following traumatic motor vehicle collision (MVC) without fractures/tissue injury. Blood plasma and RNA was collected from individuals enrolled in the emergency department (ED) following MVC trauma and MSP severity (0-10NRS) was assessed 6 weeks 6 months and 1 year following MVC. E2 levels were measured via ELISA and RNA expression via RNA seq. The association between E2 levels and post-MVC chronic MSP development (n=95) and the association between E2, RNA expression, and post-MVC chronic MSP (n=41) was assessed using repeated measures mixed models adjusted for age and ED study site. Women with higher circulating levels of E2 at the time of trauma exposure reported less severe pain following MVC compared to women with lower circulating levels of E2 (0-10NRS at 1 year: 3.24 vs 5.05, p=0.008). RNA transcripts (p

Effect of Breast Size on Upper Torso Musculoskeletal Structure and Function: A Cross-Sectional Study.

Research has shown that women with large and hypertrophic breast sizes report an increased prevalence and severity of musculoskeletal pain in the upper torso. Despite this evidence, factors contributing to the development of musculoskeletal pain among these women are poorly understood, and the threshold at which breast size becomes problematic in terms of musculoskeletal pain is currently unknown. Three hundred Australian women (aged 18 to 82 years) who volunteered as participants were divided into four breast size groups (small, breast volume <350 ml; medium, breast volume 350 to 700 ml; large, breast volume 701 to 1200 ml; and hypertrophic, breast volume >1200 ml). The thoracic flexion torque, thoracic kyphosis angle, total upper torso musculoskeletal pain score, and regional upper torso musculoskeletal pain scores derived for participants in the four groups were compared using an analysis of covariance design, controlling for age and body mass index. Thoracic flexion torque significantly increased as breast size group increased. Women with hypertrophic breasts reported significantly higher total upper torso musculoskeletal pain scores compared with women who had small, medium, and large breasts, and this was significant for the upper back, shoulders, neck, and breasts. No significant difference was found in thoracic kyphosis angle among the four groups. Musculoskeletal pain became most pronounced in women with hypertrophic breasts who had the greatest breast volume and displayed the greatest thoracic flexion torque. Clinical and/or surgical treatment for symptomatic relief should aim to either counteract thoracic flexion torque or reduce breast volume. Risk, I.

Audit of toxic effects of body paint in the tiger dancers (Hulivesha) of Mangalore, India: an investigational study

Introduction: Tiger dancing or Hulivesha, where the volunteers paint their bare body like a tiger and dance in a ritual during the Navarathri festival in Mangalore, India. There are no scientific studies done with the Hulivesha dancers at all, and therefore, we investigated the adverse effects of painting body like a tiger and dancing in the volunteers.Objective/Aim: In this study, we investigated the clinico-haematological effects of topical application of lead-containing paint and dancing for three consecutive days in these dancers to ascertain the toxic effects of whole body painting and dancing.Materials and methods: This was a case-control study and was conducted during the Dasara festival in 2013 in the Huliveshadaris (study group) and the accompanying drummers (controls). Clinical, dermatological, and musculoskeletal examination were done before (day 0) and after the three days of the function (day 3). Blood was also collected and examined for alterations in the hematological parameters, lead, antioxidant glutathione, and lipid peroxidation levels.Results: The results indicated that the all Hulivesha volunteers had severe musculoskeletal pain, while few also complained of skin reactions (61.6%), headache (25%) and nausea, and vomiting (18.75%). The results also indicated that topical application increased the levels of blood lead, caused a change in the haematological profile, decreased glutathione and increased lipid peroxidation (p < 0.03–0.0001).Conclusions: The results from this study clearly shows that topical application of the acrylic paint increases lead, changes haematological parameters and imparts adverse skin reactions.

Is Training Load Associated with Symptoms of Overuse Injury in Dancers? A Prospective Observational Study.

Overuse injuries in dance are extremely common and often difficult to treat. High training load and dancing with pain are frequently regarded as risk factors for musculoskeletal injuries in professional dancers. The aims of this study were to assess for: 1. any association between training load (TL) and symptoms of overuse injury in professional dancers, and 2. any difference between the number of "time-loss" injuries and injuries causing significant symptoms not leading to decreased performance time. Twenty-one dancers from a professional contemporary dance company were followed for 7 weeks. They completed the dance-specific Self-Estimated Functional Inability because of Pain (SEFIP) questionnaire on a weekly basis to quantify musculoskeletal pain. Their TL was calculated by multiplying the Ratings of Perceived Exertion scale (RPE Borg CR10) by the daily training time. Associations between TL and SEFIP scores, recorded on a weekly basis, were evaluated using a mixed linear model with repeated measurements. No significant association was found between TL and severity of musculoskeletal pain. However, the TL of the dancers with no symptoms of overuse-injury, SEFIP = 0, was significantly lower compared to the dancers with symptoms, SEFIP > 0; p = 0.02. No time loss because of injury was reported during the study period. There were 251 symptoms of overuse injury reported, and 67% of the recorded time was danced with pain. It is concluded that dancers without musculoskeletal pain had lower TLs. While no time-loss injuries were found, two-third of the participants danced with pain during this 7-week period.