Pain Of Musculoskeletal Origin Research Articles

Regional Anesthesia for Acute Pain Treatment in Pre-Hospital and In-Hospital Emergency Medicine.

More than half of all emergency department patients seek help for acute pain, which is usually of musculoskeletal origin. Acute pain is often inadequately treated even today, particularly in children and in older patients. In this study, we assess the potential role of regional anesthetic methods in improving the treatment of pain in the preclinical and clinical emergency setting. Pain-related reasons for admission were identified and quantified from emergency admission data. A structured literature search was carried out for clinical studies on the treatment of pain in the emergency setting, and a before-and-after comparison of the pain relief achieved with established vs. newer regional anesthetic methods was performed. 43% of emergency patients presented with acute musculoskeletal pain. The literature search yielded 3732 hits for screening; data on entity-specific pain therapy spectra were extracted from 153 studies and presented for the main pain regions. The degree of pain relief obtained through regional anesthetic procedures, on a nominal rating scale from 0 to 10, was 4 to 7 points for acute back and chest wall pain, >6 for shoulder pain, 5 to 7 for hand and forearm injuries, and >4 for hip fractures. These results were as good as, or better than, those obtained by analgesia/sedation with strong opioids. Modern regional anesthetic techniques can improve acute pain management in the emergency department and, to some extent, in the pre-hospital setting as well. Pain relief with these techniques is quantifiably better than with strong opioids in some clinical situations; moreover, there is evidence of further advantages including process optimization and fewer complications. Data for comparative study remain scarce because of a lack of standardization.

COVID-19 and musculoskeletal pain: an overview of the current knowledge.

The Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has provoked billions of infections worldwide. Several meta-analyses have observed that up to 50% of individuals who had survived to a SARS-CoV-2 acute infection suffer from post-COVID symptoms lasting for weeks or months and up to one year after infection. The prevalence of post-COVID pain ranges between 10% to 20% when assessed with other overall post-COVID symptoms and can reach up to 50% to 60% when investigated specifically. The most common musculoskeletal manifestations of post-COVID-19 condition include fatigue, myalgia, arthralgia or back pain. Despite pain of musculoskeletal origin is one of the most prevalent post-COVID pain symptoms, the exact pathophysiological mechanisms of musculoskeletal post-COVID pain are not completely understood. Studies have reported the complexity of post-COVID pain including immune, biological, and psychological factors, and more recently, they have suggested that genetic and epigenetic factors may also play a potential role, highlighting the need for further investigation into these mechanisms. Its management is still controversial, as no specific guideline for treating musculoskeletal post-COVID pain has been proposed with only general consideration about the relevance of multidisciplinary and multimodal treatment approaches. In this paper we will highlight the clinical features, the mechanism, and the management possibilities of musculoskeletal post-COVID pain.

The efficacy of the combination of diclofenac and orphenadrine in the treatment of dorsalgia

The high prevalence of dorsalgia and dorsopathy among the adult population makes a significant contribution to the structure of the financial burden of health care systems. The use of non-steroidal anti-inflammatory drugs (NSAIDs) as the basis for the pharmacotherapy of dorsopathy is recommended by most international clinical guidelines. The pharmacodynamic effects of NSAIDs underlie the clinical efficacy of this group of drugs in patients with pain of musculoskeletal origin, while monotherapy is not always accompanied by the rapid development of a persistent analgesic effect. An urgent direction in the therapy of dorsopathies may include combination of NSAIDs with analgesic drugs of other pharmacological groups capable of additive action. The fixed combination of diclofenac, 75 mg, and orphenadrine, 50 mg, allows achieving an effective analgesic effect in patients with lower back pain of various etiologies. It was demonstrated in a series of clinical cases that included 4 patients with dorsopathy who were treated at the City Clinical Hospital No. 24, Moscow in 2020.

Fork Rib: A Rare Musculoskeletal Etiology of Chest Pain

Chest pain is a common clinical presentation in daily practice. Musculoskeletal origin is a rare etiology of chest pain, compared to a cardiorespiratory problem and often underrecognized. Fork-rib or bifid-rib is a rare anomaly which uncommonly present with clinical symptoms since in most cases fork-rib incidentally found during cadaveric dissection. Here we report a 27 years old man presenting with chest pain and radiographic examination showing bifid rib of the fifth left rib, without any abnormalities from physical examination and electrocardiography. The patient treated with intravenous painkiller and anticonvulsants. Fork-rib should be considered as a differential diagnosis for chest pain of musculoskeletal origin especially in young adults or chest pain precede with minor trauma.Â

RELIEF: A practical primary care approach to chronic pain

Doctors typically receive very little training dedicated to the management of chronic pain. A practical approach to assist clinicians when assessing and managing patients with chronic pain is proposed using the RELIEF mnemonic. This approach is designed to particularly consider pain of musculoskeletal origin. It aims to avoid iatrogenic harm and to improve prescribing, investigation and referral. It also seeks to encourage effective and safer care for a challenging, often long-term illness, which is a significant burden to public health.

Assessment of heart rate variability in the patients suffering with chronic pain of musculoskeletal origin

Background: Prolonged pain of musculoskeletal origin can cause changes in autonomic outflow and thereby cardiovascular system. Various studies have been conducted showing the effect of chronic pain on heart rate variability (HRV), but the same study has not been conducted in the population of Eastern Uttar Pradesh. Aims and Objectives: This study was conducted to assess the effects of chronic pain on cardiovascular autonomic control in male cases versus male controls and female cases versus female controls. Materials and Methods: The patients were selected from the pain clinic out patient department with chronicity of >6 months duration and severity of >3 on visual analog scale. Age-sex matched controls were also selected. Electrocardiogram was recorded in the resting state and was analyzed for the HRV by using time and frequency domains. Results: In male cases, maximum RR interval, minimum RR interval, mean RR interval and in female cases, minimum RR is significantly different than male and female controls, respectively (P < 0.05). In frequency domain, low frequency/high frequency (L.F./H.F) ratio in male cases and L.F.m2 in female cases are different than male and female controls, respectively. Conclusion: The observations reveal that there is a decrease in parasympathetic activity and an increase in the sympathetic activity in the cases as compared to their age-sex matched controls leading to the shifting of sympathovagal balance toward the sympathetic side. The pattern of changes is similar, both in male cases versus male controls and female cases versus female controls with little difference in the magnitude.

Evaluation of cardiovascular autonomic control in chronic pain patients using isometric handgrip and deep breath maneuvers

Background: Chronic pain of musculoskeletal origin can cause severe and prolonged pain which, in turn, can alter the autonomic outflow and thereby cardiovascular system. Various studies have been done on this issue but the same study has not been conducted yet in the population of Eastern Uttar Pradesh, India. Aims and Objective: This study was conducted to assess the effects of chronic pain on cardiovascular autonomic control using isometric handgrip test (IHGT) and deep breath test (DBT). Materials and Methods: The patients (50 males of the mean age of 38 ± 2.2 years and 28 females of the mean age of 40.5 ± 2.0 years) having the pain of musculoskeletal origin with chronicity of >6 months duration and severity of >3 on visual analog scale were included in the study. The age-sex matched controls (58 males of the mean age of 35 ± 2.2 years and 28 females of the mean age of 39.6 ± 1.2 years) were also selected. The DBT and IHGT were performed, blood pressure (BP) and electrocardiography were recorded, and the heart rate (HR) was calculated. Results: During DBT, there is a significant difference in the HR changes in the male cases versus male controls (P < 0.05), but expiration: inspiration (E: I) ratio did not show any significant changes among various groups. In IHGT, BP changes in female cases versus female controls and male cases versus female cases were found significantly different (P < 0.05) and HR changes were also significantly different in all the three groups (P < 0.05). Conclusions: The results indicate the parasympatholytic responses in the male and female cases which are further supported by the HR changes in the IHGT. The BP responses indicate the normal sympathetic response in the female cases and subnormal response in the male cases.

Effect of Treatment on Trigger Points

Patients with muscle pain complaints commonly are seen by clinicians treating pain, especially pain of musculoskeletal origin. Myofascial trigger points merit special attention because its diagnosis requires examinations skills and its treatment requires specific techniques. If undiagnosed, the patients tend to be overinvestigated and undertreated, leading to chronic pain syndrome. Patients with myofascial pain syndrome present primarily with painful muscle(s) and restricted range of motion of the relevant joint. Palpable painful taut bands are named trigger points and are the main and pathognomonic finding on physical examination. Eliciting local twitch response and referred pain requires experience and examination skills. It may be useful to classify the patient as having acute or chronic, and as having primary or secondary, myofascial pain so the decision on the details of treatment can be curtailed to the needs of each patient. Effective treatment modalities are local heat and cold, stretching exercises, spray-and-stretch, needling, local injection, and high-power pain threshold ultrasound.

Medical Costs of Chronic Musculoskeletal Pain in Italy

Musculoskeletal system problems are responsible for more than two-thirds of painful conditions in primary care. However, only one published study, conducted in Finland, has analysed the costs of managing musculoskeletal pain as a whole in primary care. This study analysed the costs of diagnosing and treating chronic musculoskeletal pain in primary care in Italy. A secondary aim of the study was to assess the impact of different drug treatment patterns on medical costs associated with musculoskeletal pain. Chronic pain of musculoskeletal origin was defined as continuous or recurrent pain persisting over 3 months with involvement of the musculoskeletal system, i.e. arising from primary musculoskeletal disorders or from the late consequences of external events (injuries, medical care or surgery). A total of 52 general practitioners (GPs) recruited 581 patients. We focussed on the differences between patients treated (410) and not treated (171) with drugs. Within the treated group, we also analysed subgroups given non-selective NSAID-based therapy (subgroup A, 169 patients) or cyclo-oxygenase-2 (COX-2) inhibitor-based therapy (subgroup B, 52 patients). The annual average cost of treating a patient with chronic musculoskeletal pain was euro 212.60. Hospital admissions and GP consultations were the largest cost components, both accounting for around a quarter of the total cost. Not surprisingly, the treated group included older patients, who had more co-morbidities and more severe pain. This was associated with annual costs more than four times those of untreated patients (euro 274.50 vs euro 63.90, respectively). Subgroups A and B did not differ with respect to major demographic and clinical variables except in relation to mean age (63 vs 70 years, respectively; p=0.037). They had similar per-patient costs (euro 186.20 vs euro 172.90), although these totals comprised a different mix of components. The analysis showed that the annual average cost of treatment of chronic musculoskeletal pain in Italy varied considerably depending on whether drug treatment was used. COX-2 inhibitors and traditional NSAIDs had similar per-patient costs, although this similarity stemmed from a different mix of components.

Pain in the Emergency Department with One‐Week Follow‐Up of Pain Resolution

To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post-discharge, and the postdischarge treatment of pain. Patients (n=871) admitted to two urban, university-affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self-reported, and chart reviews of the assessment, immediate treatment and follow-up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585). Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One-quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities. More than one-third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.

Post-herpetic neuralgia: Possible mechanisms for pain relief with manual therapy

This case report details the history, presentation, and treatment of a patient with a diagnosis of postherpetic neuralgia (PHN). The pathophysiology behind the development of PHN following infection with the varicella zoster virus (VZV) is discussed, although the exact mechanisms remain unclear. The subjective and objective findings in this patient with PHN are highlighted to alert other clinicians to the possibility of PHN as a differential diagnosis when patients attend the clinic for what they perceive to be pain of musculoskeletal origin. Following a description of the simple treatment approach that was adopted with this patient, possible mechanisms of action for this intervention are considered in relation to what is known of the underlying pathophysiology. However, it is not the author’s intention to propose manual therapy as a standard intervention for this condition.

Beenpijn bij jonge atleten, opgewekt door training, die ten onrechte wordt gezien als pijn met oorsprong in het bewegingsapparaat

Exercise induced leg pain in young athletes misdiagnosed as pain of musculo-skeletal origin [Manual Therapy 2001;6(1):48-52]

Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy. (Logan College of Chiropractic, St. Louis, MO) Spine. 2001;26:1117–1124.

This is the first study demonstrating neuromuscular reflex responses associated with mechanical force, manually assisted (MFMA) spinal manipulative therapy in patients with low back pain. Noteworthy was the finding that such mechanical stimulation of both the paraspinal musculature stimulation and spinous processes produced consistent generalized sEMG responses. Identification of neuromuscular characteristics, together with a comprehensive assessment of patient clinical status, may provide for clarification of the significance of spinal manipulative therapy in eliciting putative conservative therapeutic benefits in patients with pain of musculoskeletal origin.

Exercise induced leg pain in young athletes misdiagnosed as pain of musculo-skeletal origin

Exercise induced leg pain in young athletes misdiagnosed as pain of musculo-skeletal origin

Analgesic and analgesia-potentiating action of B vitamins

Disregarding pain resulting from vitamin deficiency, an analgesic effect seems to be exerted only by vitamin B1 (thiamine), vitamin B6 (pyridoxines), and vitamin B12 (cobalamine), particularly when the three are given in combination. The analgesic effect is attributed to an increased availability and/or effectiveness of noradrenaline and 5-hydroxytryptamine acting as inhibitory transmitters in the nociceptive system. In animal experiments, high doses of these vitamins administered alone or in combination inhibited nociceptive behavior and depressed the nociceptive activity evoked in single neurons of the dorsal horn of the spinal cord and in the thalamus. Moreover, they were found to enhance the antinociceptive effect of non-opioid analgesic agents on withdrawal reflexes. Clinical data fail in most cases to meet current standards of evaluation (randomization, double-blindness). Still, it appears that high doses of the vitamins B1, B6, and B12 administered separately or in combination can alleviate acute pain and potentiate the analgesia caused by non-opioid analgesics such as the NSAIDs and metamizol (dipyrone). Therapeutic effects are observed in neuropathic pain and pain of musculoskeletal origin. Vitamin B6 is effective in the carpal tunnel syndrome which, however, is attributed at least in some cases to vitamin B6 deficiency. It is also worth noting that the B vitamins are shown to enhance the beneficial effect of diclofenac in acute low-back pain so that either the duration of treatment or the daily dose of diclofenac may be reduced. The use of high doses of vitamin B6 may be limited by a neurotoxic effect. The effectiveness of B vitamins in depressing chronic pain has not been established. It would be interesting to know if the B vitamins are of use as adjuvants in the treatment of tumor pain.