Musculoskeletal Pain Sites Research Articles

Physical workload during caregiving activities and related factors among the caregivers of children with cerebral palsy.

Caregiving demands contribute to both psychological and physical health of caregivers. Physical workload (PW) can be an important cause of musculoskeletal disorders in caregivers of children with cerebral palsy (CP). To investigate PW during caregiving activities and related factors among caregivers of children with CP. Children with CP (n = 291) and their caregivers (n = 291) were recruited for this cross-sectional study. Caregivers were categorized as their child has presence of intellectual disability (ID) and independent walking ability. Gross motor function was assessed using the Gross Motor Function Classification System (GMFCS) in children. PW; presence and distribution of musculoskeletal pain sites; levels of disability of neck, low back, arm, and leg; levels of depressive symptoms; and health-related quality of life (HRQOL) were assessed in caregivers. Significant differences were observed in PW, low back pain-related disability, depressive symptoms, and HRQOL between caregivers of children with and without an ID (p < 0.05). All study variables were significantly different between caregivers of children who can and cannot independently walk (p < 0.05). PW was correlated with caregiver's age, body mass index, lower extremity dysfunction, depressive symptoms, and child's GMFCS level (p < 0.05). Caregivers of a child having an ID and walking disability had higher PW. These caregivers had more problems related to musculoskeletal disorders, higher depressive symptoms, and lower HRQOL. Higher PW was associated with lower level of gross motor function of child and older age, higher body mass index, higher level of lower extremity disfunction and low back pain disability, and lower HRQOL of caregivers.

Carpel tunnel syndrome: A link with vitamin D and calcium

Carpal tunnel syndrome (CTS) and vitamin D deficiency are two conditions that cause chronic pain and are thus associated with psychological issues as well. The aim of the present study was to evaluate vitamin D levels, daily calcium intake, musculoskeletal pain and psychological symptoms in patients with CTS. The study included 48 patients with CTS and age-sex matched controls. Serum vitamin D levels were measured, and psychological symptoms were assessed using a Hospital Anxiety and Depression Scale. A Pain DETECT questionnaire was used to assess musculoskeletal pain (MSP) sites and severity. The results showed that vitamin D deficiency was considerably more prevalent in patients with CTS (95.8%) compared with controls (22.9%). Clinical anxiety (35.4 vs. 6.3%) and clinical depression (29.2 vs. 4.2%) were also more common in patients with CTS compared with controls. All the patients with CTS exhibited MSP, whereas none of the controls reported any MSP. Anxiety was significantly and inversely associated with vitamin D levels (r2=-0.482; P<0.01), total daily calcium intake (r2=-0.294: P<0.05), and positively associated with body mass index (BMI; r2=0.200; P≤0.05) and depression (r2=0.587; P<0.01). Depression was significantly and inversely associated with vitamin D levels (r2=-0.269; P<0.01) and total daily calcium intake (r2=-0.236; P<0.05). Logistic regression analysis showed that with every unit increase in serum vitamin D levels, the odds of CTS were decreased 1.22x. While a one-unit increase in anxiety total score was associated with a 14% increase in the odds of having CTS after adjusting for different confounders. In conclusion, vitamin D deficiency, MSP and psychological symptoms are common in patients with CTS. Serum vitamin D levels and anxiety were significant independent predictors of CTS. Based on the results of the present study, it was shown that housewives had an equivalent chance of suffering from CTS morbidity as other high-risk professions. Further studies are required to confirm if vitamin D supplementation could prevent the onset of CTS.

A Cross Sectional Study of Spinal Cord Injury-Induced Musculoskeletal Pain

Background:Musculoskeletal pain is a common consequence in a person with spinal cord injury. It brings a major impact on the quality of life, making prone to complications in both the short and the long term.Purpose: The purpose of the study to determine the spinal cord injury-induced musculoskeletal pain.Materials and Methods: A cross-sectional study was conducted at two different reputed institutes in Dhaka city. Ninety spinal cord injury subjects were selected with their inform consent. Data were collected by face to face interview with the interviewer-administered structured questionnaire. Numerical Pain Rating Scale was used to assess the grade of musculoskeletal pain and American Spinal Injury Association scale was used to find out the types of injury. Chi-square test was used where p-value (p<0.05) indicated as the level of significance.Results: Results indicated that more than two-third of the person with spinal cord injury complained to musculoskeletal pain. Neck, shoulder, and back were the more prevalent site of musculoskeletal pain found in this study. Road traffic accident and fall from height were the common causes of injury. Cervical and thoracic levels were the vulnerable site in person with spinal cord injury. However, there was a highly significant relationship found between the level of injury and musculoskeletal pain (p=0.001<0.05).Conclusion: The prevalence of musculoskeletal pain is extremely high in person with spinal cord injury which is concluded in this study. Some factors like spinal levels and causes of injury are significantly accountable for musculoskeletal pain. Adequate physiotherapy might help to reduce the incidence and intensity of spinal cord injury-induced musculoskeletal pain.

Influence of severe knee pain, meniscus surgery and knee arthroplasty on physical ability: an observational study of 114 949 adults in the CONSTANCES cohort

BackgroundThe knee is one of the major sites of musculoskeletal pain, yet few large-scale studies have evaluated the impact of knee disorders on physical limitations. Our objective was to describe...

Effects of psychosocial work factors on number of pain sites: The role of sleep quality as mediator

BackgroundObjective of the current study was to determine which of thirteen specific psychosocial work factors were related to number of musculoskeletal pain sites (NPS) prospectively over a two-year time span. Furthermore, the study aimed to explore possible mediation of these prospective relationships through sleep problems.MethodsThe study was a two-wave full panel study. Participants included 6277 employees of Norwegian companies, representing a wide range of occupations. Structural equation modelling was employed to analyze direct and indirect effects of thirteen specific psychological- and social work factors on sleep problems and NPS.ResultsOut of the thirteen work factors studied, positive challenges at work, role conflict, decision control, superior support, coworker support, empowering leadership, and social climate were statistically significantly related to subsequent NPS, both directly and indirectly through sleep quality. Sleep quality was related to NPS in all analyses. Most psychosocial work factors exhibited direct effects on either sleep or number of pain sites. Decision demands and control over work pacing were not statistically significantly related to sleep or pain.ConclusionIn conclusion, the results suggested sleep quality to be involved in the mechanisms by which work affects the number of pain complaints employees experience.SignificanceFindings from this study suggest sleep may play a role in the complex mechanism from work stressors to musculoskeletal pain. Workplace interventions aiming to reduce musculoskeletal pain may wish to target work factors described in this study, as they affect sleep and may thereby increase number of musculoskeletal pain sites.

A systematic review of the cross-cultural adaptations and measurement properties of the Shoulder Pain and Disability Index

IntroductionThe shoulder is the leading site of musculoskeletal pain. Patient-reported outcomes, such as the Shoulder Pain and Disability Index (SPADI), allow us to assess shoulder pain in a clinic...

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.

Coexistence of Chronic Musculoskeletal Pain and Depressive Symptoms and Their Combined and Individual Effects on Onset of Disability in Older Adults: A Cohort Study

ObjectivesCoexistence of chronic musculoskeletal pain and depressive symptoms is common, and their combined effect on adverse events warrants investigation. The purpose of this study was to investigate the individual and combined effect of chronic musculoskeletal pain and depressive symptoms on the onset of disability, which is a crucial outcome in older adults. DesignA 1-year cohort study. Setting and participants1251 community-dwelling older adults. MeasurementsThe number of chronic musculoskeletal pain sites was measured using a self-reported questionnaire. Depressive symptoms were assessed using the Geriatric Depression Scale–15. Disability was self-reported as any difficulty in basic activities of daily living. Incidence of disability was defined as any difficulty in performing 1 or more tasks at the follow-up assessment, that was absent at baseline. ResultsOlder adults with more chronic musculoskeletal pain sites tend to have depressive symptoms at baseline (P for trend < .001). Compared to older adults without both chronic musculoskeletal pain and depressive symptoms, older adults with both chronic multisite musculoskeletal pain and depressive symptoms have the higher risk for development of disability (adjusted odds ratio: 6.84, 95% confidence interval: 3.72 to 12.58), followed by older adults with chronic multisite musculoskeletal pain and without depressive symptoms (adjusted odds ratio: 2.13, 95% confidence interval: 1.35 to 3.37). Conclusions/ImplicationsSimultaneous assessment of both chronic musculoskeletal pain and depressive symptoms may be useful for accurate prognosis and preventing disability in older adults.

Musculoskeletal pains and cardiovascular autonomic function in the general Northern Finnish population

BackgroundHeart rate variability (HRV) and baroreflex sensitivity (BRS) measurements provide means for the objective assessment of cardiovascular autonomic function. As previous studies have associated chronic pain with abnormal autonomic function, we aimed to characterize the relationship between the number of musculoskeletal pain sites (NPS), pain intensity, and cardiovascular autonomic function among the population-based Northern Finland Birth Cohort 1966.MethodsAt the age of 46, cohort members self-reported their musculoskeletal pains (enabling the determination of NPS [0–8] and pain intensity [Numerical Rating Scale, NRS, 0–10]) and underwent clinical assessments of cardiovascular autonomic function in seated and standing positions (HRV variables: heart rate [HR] and root mean square of successive differences in beat-to-beat intervals [rMSSD] for the entire cohort; BRS variables: low-frequency systolic blood pressure variability [SBPV] and cross-spectral baroreflex sensitivity [BRS] for those attending the examination in Oulu, Finland). Extensive confounder data were also collected (body mass index, physical activity, smoking, Hopkins Symptom Checklist-25, comorbidities, and medications). The full samples included 4186 and 2031 individuals (HRV and BRS samples, respectively). Three subanalyses focused on individuals with intense and frequent pain, individuals with symptoms of depression and anxiety, and the relationship between pain intensity and autonomic parameters.ResultsLinear regression models showed varying associations between NPS, pain intensity, and cardiovascular autonomic parameters. However, after all adjustments NPS was only associated with one outcome among women (BRS, standing: beta = − 0.015, p = 0.048) and two among men (HR, seated: beta = − 0.902, p = 0.003; HR, standing: beta = − 0.843, p = 0.014). Pain intensity was not associated with any outcome after full adjustments. Significant sex*pain interactions were found in the data.ConclusionsOur data suggest that musculoskeletal pain has, at most, a limited independent association with cardiovascular autonomic function. Future studies should carefully account for the potential confounders and sex interactions that this study revealed.

The Site of Musculoskeletal Pain in School Children with Excessive Body Weight and Obesity in Bosnia and Herzegovina.

Introduction:The number of school age children with excessive body weight and perception of musculoskeletal pain is on the rise.Aim:The aim of this study is to identify the most common sites of acute and chronic musculoskeletal pain in school children with excessive body weight and obesity.Methods:A survey included 1315 children aged 9-14 years from September 2016 to January 2017 in the Primary schools of Canton Tuzla. The weight and height were measured for each subject based on which a body mass index was determined and two groups were categorized: a group of children with excessive BMI and obesity (N = 406), and the remaining respondents were part of the control group. The Nordic questionnaire was utilized to examine places of perception of musculoskeletal pain experienced by children in the preceding 7 days (acute) or preceding 1 year (chronic pain).Results:Prevalence of overweight and obesity in school children is 31% (significantly higher in boys than in girls, 38%: 25%). The incidence of acute and chronic pain in children with normal BMI 49% is significantly higher than in excessive BMI 45% or in children with overweight 39.1%. Obesity and overweight are risk factors for the development of nonspecific musculoskeletal pain (OR = 1.161, 95% CI, 1.020-1.322). The most common places for chronic pain associated with overweight and obesity are neck (OR = 1.212, 95% CI, 0.893-1.644) and knee (OR = 1.103, 95% CI, 0.690-1.760). While the most common place of acute pain is knee (OR = 1.127 , 95% CI, 0.673-1.890).Conclusion:The relationship between excessive body weight and chronic musculoskeletal pain (MSP) in the neck and knees indicates the cumulative effect of exposure to excessive body weight and obesity in BiH school children.

Factors associated with pain in adolescents with bilateral cerebral palsy

We explored factors associated with pain and its severity in a population cohort of young people with bilateral cerebral palsy, comparing parent/carer and young people self-reports. Of 278 survivors (mean age 16y 8mo, SD 1y 4mo, range 13y 8mo-19y 3mo) from the South Thames in the Study of Hips and Physical Experience cohort of 338 young people with bilateral cerebral palsy, 212 parents/carers and 153 young people completed questionnaires on the presence, severity, timing, site, associated factors, impact, and treatment of pain. Seventy per cent of parents/carers reported pain within 3 months, 59% the previous week, and 50% the previous day with 56% reporting 'regularly experienced'. Of young people able to do so, 63% reported pain within 3 months, 50% the previous week, and 42% the previous day, with 48% reporting regular pain. There was strong agreement between the parent/carer and young people, reporting pain severity over the previous 3 months. Pain severity was associated with increased motor impairment and comorbidity, particularly constipation, spasticity, equipment use, and higher emotional score, but not sex, intellectual disability, speech, or maternal education. Multiple sites of musculoskeletal pain were reported in two-thirds of individuals. Pain was associated with voluntary movement in individuals with less motor impairment and with being moved in those with severe motor impairment. Greater pain severity had a negative effect on both physical and psychological quality of life. Increasing awareness of the comorbidities in cerebral palsy may aid effective treatment, reducing pain experienced by young people with cerebral palsy. Regular moderate or severe pain is reported in young people with bilateral cerebral palsy (CP) in all Gross Motor Function Classification System levels. Pain is reported more frequently in young people who are non-ambulant. General ill health is strongly associated with severity of pain after controlling for severity of CP, especially constipation. Pain occurs most often in ambulant young people during voluntary activity and in those who are non-ambulant when being moved. There is strong agreement between parents/carers and young people about pain presence and severity.

Musculoskeletal pain and symptoms in pregnancy: a descriptive study.

Background:Pregnancy-induced hormonal and physiologic changes increase the risk of musculoskeletal problems in pregnancy. The purpose of this report is to provide a comprehensive look at the musculoskeletal pain and symptoms experienced during pregnancy.Methods:A total of 184 women (mean age 30.9 ± 5.0 years) who gave birth in the obstetrics clinic of a tertiary hospital were included in the study. The participants who had given birth at 37–42 weeks of pregnancy (term pregnancy) and aged over 18 years were selected for participation. Basic demographic and clinical characteristics of the participants including age, body mass index, weight gained during pregnancy, education level, occupation, parity, sex of baby, and exercise habits were collected from the medical chart and face-to-face interviews. Musculoskeletal pain sites were defined as hand–wrist, elbow, shoulder, neck, back, low back, hip, knee, and ankle–foot in a diagram of the human body. The interviews with participants were performed to assess their musculoskeletal pain separately at each trimester follow-up visit.Results:The most frequent musculoskeletal complaints during pregnancy were low back pain (n = 130, 70.7%), back pain (n = 80, 43.5%), hand–wrist (n = 61, 33.2%) and hip pain (n = 59, 32.1%). The participants experienced musculoskeletal pain most in the third trimester except for elbow, shoulder and neck pain compared with the first and second trimesters (p < 0.05).Conclusions:The results of the study suggest that numerous musculoskeletal problems may complicate pregnancy especially in the third trimester.

Survey of Musculoskeletal Pain among Dental Clinician in Kulliyyah of Dentistry IIUM

This study aimed to determine the prevalent site of musculoskeletal pain and its associated risk factors among dental clinicians at the Kulliyyah of Dentistry, IIUM. A validated, pilot-tested self-administered questionnaires were distributed to 160 dental clinicians between March and June 2014 using convenience sampling method. Inclusion criteria includes dentist, clinical supervisors or clinical dental students. Dental clinicians whom were diagnosed with musculoskeletal disorders were excluded. Data obtained were recorded and analyzed using statistical package for the social science (SPSS) software version 19. Pearson correlation test was used to determine the association between the risk factors and pain sites. A total of 146 participants completed the questionnaire (91.3% response rate). The sample consist of 40 dentists (27.4%), 36 Year 3 students (24.7%) and 35 participants (24%) respectively from Year 4 and Year 5. There was high prevalence of neck pain (79.5%), back shoulder pain (74.7%) and lower back pain (71.9%) among dental clinicians. Significant correlation was found between physical activities with upper body region pain sites (r = 0.170, p=0.042) and lower body region pain sites (r = 0.221, p=0.008). There was a significant association between repetitive movements and wrist bending with upper and lower body region pain sites (r = 0.320, p = &lt;0.001) (r = 0.278, p =0.001). No correlation between awkward postures with upper and lower body pain sites. This paper will relate to the Islamic teaching on moderation in working and in maintaining healthy lifestyle. The most prevalent site of musculoskeletal pain experienced by dental clinicians was at the neck area and the least was on the left arm. Repetitive movements, wrist bending and physical activities were associated with upper and lower body region pain sites.

Musculoskeletal Pain is Associated With New-Onset Psychological Distress in Survivors of the Great East Japan Earthquake.

Psychological distress is a common symptom after natural disasters. Although musculoskeletal pain also increases after natural disasters, its relation to psychological distress is not known. This study aimed to examine the association of musculoskeletal pain with new-onset psychological distress among survivors of the Great East Japan Earthquake. A panel study was conducted with survivors at 2 and 3 years after the Great East Japan Earthquake. New-onset psychological distress was defined as psychological distress absent at 2 years and present at 3 years after the disaster. The number of musculoskeletal pain sites at 2 years after the disaster was divided into 3 categories (0, 1, and ≥2). Multivariate logistic regression models were used to calculate the odds ratio and 95% confidence interval for new-onset psychological distress according to the number of musculoskeletal pain sites. The rate of new-onset psychological distress was 6.7%. Musculoskeletal pain was associated with new-onset psychological distress. Using "0" as a reference, the adjusted odds ratios (95% confidence interval) were 1.65 (0.92-2.95) in "1" and 2.12 (1.24-3.64) in "≥2" (P for trend=.02). Musculoskeletal pain is associated with new-onset psychological distress among survivors of the Great East Japan Earthquake. (Disaster Med Public Health Preparedness. 2019;13:295-300).

Association Between Objectively Measured Physical Activity and the Number of Chronic Musculoskeletal Pain Sites in Community-Dwelling Older Adults.

Physical inactivity is recognized as a pandemic health problem. The association of pain with physical activity, particularly when measured objectively, in older adults is unclear. This study investigates the association of number of chronic musculoskeletal pain sites and pain severity with objectively measured physical activity in community-dwelling older adults. Observational study. Community. We analyzed 267 community-dwelling older adults (mean age = 75.3 years, 67.0% women). Number of chronic musculoskeletal pain sites and pain severity were measured using a self-reported questionnaire. Mean steps per day and mean minutes of light physical activity per day and moderate to vigorous physical activity per day were measured using an accelerometer. Linear regression models were applied to analyze the association of number of chronic musculoskeletal pain sites and pain severity with physical activity. The results suggest that a higher number of chronic musculoskeletal pain sites is associated with lower step count (beta = -333.5, 95% confidence interval = -655.9 to -11.0, P < 0.05) and moderate to vigorous physical activity (beta = -2.5, 95% confidence interval = -4.7 to -0.4, P < 0.05) even after adjustment for age, gender, years of schooling, obesity, alcohol habits, smoking status, number of comorbidities, recent surgery, and depressive symptoms. Our results suggest that the number of chronic musculoskeletal pain sites is associated with low physical activity in older adults. Therefore, low physical activity due to chronic musculoskeletal pain should not be overlooked.

The smallest worthwhile effect of primary care physiotherapy did not differ across musculoskeletal pain sites

ObjectivesTo determine and compare estimates of the smallest worthwhile effect (SWE) for physiotherapy in neck, shoulder, and low-back pain patients and to investigate the influence of sociodemographic, clinical, and psychological factors on these estimates. MethodsA structured telephone interview was conducted before treatment was commenced in 160 patients referred for primary care physiotherapy. The benefit-harm trade-off method was used to estimate the SWE of physiotherapy for the following outcomes; pain, disability, and time to recovery, compared with the improvement achieved without any treatment (natural course). Regression analyses were used to assess the influence of sociodemographics, clinical variables, and intake scores on pain, disability, and psychological scales. ResultsThe median SWE for improvements on pain and disability was 20% (interquartile range 10%–30%), and the SWE for time to recovery was 10 days (interquartile range 7–14 days) over a period of 6 weeks. These estimates did not differ with respect to pain location (neck, shoulder, or back) and were generally unaffected by sociodemographic, clinical, and psychological factors. ConclusionPeople with neck, shoulder, and low-back pain need to see at least 20% of additional improvement on pain and disability compared with natural recovery to consider that the effect of physiotherapy is worthwhile, given its costs, potential side effects, and inconveniences.

Musculoskeletal pain in Primary Care Physiotherapy: Associations with demographic and general health characteristics

BackgroundMany patients reporting musculoskeletal pain present to Primary Care Physiotherapy with costly comorbid overlapping complaints that remain medically unexplained. These subjective health complaints (SHC) incorporate coexisting multi-site musculoskeletal pain and varied non-musculoskeletal complaints (e.g. anxiety, tiredness). The role of these non-musculoskeletal complaints is acknowledged in spinal musculoskeletal disorders, but less so for peripheral musculoskeletal disorders. ObjectiveThis cross-sectional study explored the relationships between self-reported musculoskeletal pain sites, non-musculoskeletal complaints and disability among people reporting spinal or peripheral musculoskeletal pain. MethodsFifty individuals with spinal musculoskeletal pain and fifty with peripheral musculoskeletal pain provided data on disability, number of musculoskeletal pain sites and non-musculoskeletal complaints. Relationships between these variables were examined for each group using Pearson's correlation coefficient and linear regression analysis. ResultsParticipants with spinal musculoskeletal pain recorded significantly more pain sites and non-musculoskeletal complaints than participants with peripheral musculoskeletal pain. However, there was no significant difference in disability between the groups. Non-musculoskeletal complaints were significantly associated with disability (correlation = 0.41, p < 0.01) and number of pain sites (correlation = 0.42, p < 0.01). Number of pain sites and disability were not significantly associated in either group. Participants with spinal musculoskeletal pain reported more tiredness, dizziness, anxiety and sleep problems. Participants reporting dizziness, anxiety, sadness/depression and sleep problems had higher disability. ConclusionFurther studies must confirm the robustness of these associations, to permit comparisons between clinical and general populations and aid identification of causal factors. Considering SHC within individualised management programmes may improve outcomes.

Clinical course and prognostic factors across different musculoskeletal pain sites: A secondary analysis of individual patient data from randomised clinical trials.

Previous research has identified similar prognostic factors in patients with musculoskeletal (MSK) conditions regardless of pain presentation, generating opportunities for management based on prognosis rather than specific pain presentation. Data from seven RCTs (2483 participants) evaluating a range of primary care interventions for different MSK pain conditions were used to investigate the course of symptoms and explore similarities and differences in predictors of outcome. The value of pain site for predicting changes in pain and function was investigated and compared with that of age, gender, social class, pain duration, widespread pain and level of anxiety/depression. Over the initial three months of follow-up, changes in mean pain intensity reflected an improvement, with little change occurring after this period. Participants with knee pain due to osteoarthritis (OA) showed poorer long-term outcome (mean difference in pain reduction at 12months -1.85, 95% CI -2.12 to -1.57, compared to low back pain). Increasing age, manual work, longer pain duration, widespread pain and increasing anxiety/depression scores were significantly associated with poorer outcome regardless of pain site. Testing of interactions showed some variation between pain sites, particularly for knee OA, where age, manual work and pain duration were most strongly associated with outcome. Despite some differences in prognostic factors for trial participants with knee OA who were older and had more chronic conditions, similarity of outcome predictors across regional MSK pain sites provides evidence to support targeting of treatment based on prognostic factors rather than site of pain. Individual patient data analysis of trials across different regional musculoskeletal pain sites was used to evaluate course and prognostic factors associated with pain and disability. Overall, similarity of outcome predictors across these different pain sites supports targeting of treatment based on prognostic factors rather than pain site alone.

Higher Incidence of Sleep Disturbance among Survivors with Musculoskeletal Pain after the Great East Japan Earthquake: A Prospective Study.

Sleep disturbance is a common symptom after natural disasters. Although musculoskeletal pain also increases after natural disasters, its relation to sleep disturbance is not clear. The purpose of this study was to determine the influence of musculoskeletal pain on new-onset sleep disturbance among survivors after the Great East Japan Earthquake (GEJE). A prospective cohort study was conducted with the survivors of the GEJE at two and three years after the earthquake. New-onset sleep disturbance was defined as sleep disturbance absent at two years and present at three years after the earthquake. The sites of musculoskeletal pain included low back, shoulder, knee, and hand or foot. The number of musculoskeletal pain sites at two years after the earthquake was divided into three categories (0, 1, and 2 or more). Univariate and multivariate logistic regression models were used to calculate the odds ratio (OR) and 95% confidence interval (95%CI) for new-onset sleep disturbance according to the number of musculoskeletal pain sites. A total of 1,102 survivors were included in this study and 14.6% of the participants reported new-onset sleep disturbance. Using "0" as a reference, the adjusted ORs (95% CI) for new-onset sleep disturbance were 2.43 (1.55-3.80) in "1" and 2.96 (1.88-4.64) in "2 or more", respectively (P for trends < 0.001). In conclusion, this is the first study showing higher incidence of sleep disturbance among survivors with musculoskeletal pain after the GEJE. Care for musculoskeletal pain is important to prevent sleep disturbance after natural disasters.

Characteristics of Plantar Pressures and Related Pain Profiles in Elite Sprinters and Recreational Runners.

Plantar pressure measurement is effective for assessing plantar loading and can be applied to evaluating foot performance. We sought to explore the characteristics of plantar pressures in elite sprinters and recreational runners during static standing and walking. Arch index (AI) values, regional plantar pressure distributions (PPDs), and footprint characteristics were examined in 80 elite sprinters and 90 recreational runners using an optical plantar pressure measurement system. Elite sprinters' pain profiles were examined to evaluate their most common pain areas. In recreational runners, AI values in males were in the normal range and in females were high arch type. The AI values were significantly lower in elite sprinters than in recreational runners. In elite sprinters, particularly males, the static PPD of both feet was higher at the medial metatarsal bone and the lateral heel and lower at the medial and lateral longitudinal arches. Elite male sprinters' PPD of both feet was mainly transferred to the medial metatarsal bone and decreased at the lateral longitudinal arch and the medial heel during the midstance phase of walking. The lateral knee joint and biceps femoris were the most common sites of musculoskeletal pain in elite sprinters. Elite sprinters' AI values could be classified as high arches, and their PPD tended to parallel the features of runners and high-arched runners. These findings correspond to the profile of patellofemoral pain syndrome (PFPS)-related plantar pressure. The pain profiles seemed to resonate with the symptoms of high-arched runners and PFPS. A possible link between high-arched runners and PFPS warrants further study.