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Pain Jul 2023Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no...
Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no EGMs within the broad domain of chronic musculoskeletal (MSK) pain in adults. The aim of this study was to create a contemporary EGM of interventions and outcomes used for research investigating chronic MSK pain. This EGM was based on systematic reviews of interventions published in scientific journals within the past 20 years. Embase, PubMed, the Cochrane Library, and PsycINFO were used to retrieve studies for inclusion. The quality of the included reviews was assessed using AMSTAR-II. Interventions were categorised as either physical, psychological, pharmacological, education/advice, interdisciplinary, or others. Outcomes were categorised using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Of 4299 systematic reviews, 457 were included. Of these, 50% were rated critically low quality, 25% low quality, 10% moderate quality, and 15% rated high quality. Physical interventions (eg, exercise therapy) and education were the most common interventions reported in 80% and 20% of the studies, respectively. Pain (97%) and physical functioning (87%) were the most reported outcomes in the systematic reviews. Few systematic reviews used interdisciplinary interventions (3%) and economic-related outcomes (2%). This contemporary EGM revealed a low proportion of high-quality evidence within chronic MSK pain. This EGM clearly outlines the lack of high-quality research and the need for increased focus on interventions encompassing the entire biopsychosocial perspective.
Topics: Adult; Humans; Chronic Pain; Exercise Therapy; Musculoskeletal Pain; Pain Measurement; Review Literature as Topic
PubMed: 36602421
DOI: 10.1097/j.pain.0000000000002855 -
The Medical Clinics of North America Sep 2020Persistent pain in older adults is a widely prevalent and disabling condition that is the manifestation of multiple contributing physical, mental, social, and... (Review)
Review
Persistent pain in older adults is a widely prevalent and disabling condition that is the manifestation of multiple contributing physical, mental, social, and age-related factors. To effectively treat pain, the clinician must assess and address contributing factors using a comprehensive approach that includes pharmacologic and nonpharmacologic therapies within the context of a strong therapeutic relationship among the patient, caregivers, and a multidisciplinary team. This article reviews the current understanding of persistent pain in older adults and suggests a general approach to its assessment and management, followed by specific considerations for musculoskeletal pain conditions commonly seen in older adults.
Topics: Aged; Chronic Pain; Geriatric Assessment; Humans; Musculoskeletal Pain; Pain Management
PubMed: 32773050
DOI: 10.1016/j.mcna.2020.05.002 -
Work (Reading, Mass.) 2022The recent mandate for university faculty and staff to work-from-home (WFH) during the COVID-19 pandemic has forced employees to work with sub-optimal ergonomic...
BACKGROUND
The recent mandate for university faculty and staff to work-from-home (WFH) during the COVID-19 pandemic has forced employees to work with sub-optimal ergonomic workstations that may change their musculoskeletal discomfort and pain. As women report more work-related musculoskeletal discomfort (WMSD), this effect may be exacerbated in women.
OBJECTIVE
The purpose of this study was to describe university employee at-home office workstations, and explore if at-home workstation design mediates the effect of gender on musculoskeletal pain.
METHODS
University employees completed a survey that focused on the WFH environment, at home workstation design and musculoskeletal pain. Descriptive statistics and regression analysis were used to analyze the responses.
RESULTS
61% of respondents reported an increase in musculoskeletal pain, with the neck, shoulders and lower back being reported most frequently. Women reported significantly greater musculoskeletal pain, but this relationship was significantly mediated by poor ergonomic design of the home workstation. Improper seat-height and monitor distance were statistically associated with total-body WMSD.
CONCLUSIONS
WFH has worsened employee musculoskeletal health and the ergonomic gap between women and men in the workspace has persisted in the WFH environment, with seat height and monitor distance being identified as significant predictors of discomfort/pain.
Topics: COVID-19; Ergonomics; Female; Humans; Male; Musculoskeletal Diseases; Musculoskeletal Pain; Occupational Diseases; Pandemics; SARS-CoV-2
PubMed: 35095004
DOI: 10.3233/WOR-210692 -
The Journal of Orthopaedic and Sports... Oct 2017Synopsis Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants,...
Synopsis Accurate, reliable, and timely assessment of pain is critical for effective management of musculoskeletal pain conditions. The assessment of pain in infants, children, and adolescents with and without cognitive impairment can be particularly challenging to clinicians for a number of reasons, including factors related to the consultation (eg, heterogeneous patient population, time constraints), the clinician (eg, awareness/knowledge of available pain scales), standardized assessment scales (eg, availability, psychometric properties, and application of each scale), the patient (eg, developmental stage, ability to communicate), and the context in which the interaction took place (eg, familiarity with the setting and physiological and psychological state). As a result, pain is frequently not assessed or measured during the consultation and, in many instances, underestimated and undertreated in this population. The purpose of this article is to provide clinicians with an overview of scales that may be used to measure pain in infants, children, and adolescents. Specifically, the paper reviews the various approaches to measure pain intensity; identifies factors that can influence the pain experience, expression, and assessment in infants, children, and adolescents; provides age-appropriate suggestions for measuring pain intensity in patients with and without cognitive impairment; and identifies ways to assess the impact of pain using multidimensional pain scales. J Orthop Sports Phys Ther 2017;47(10):712-730. doi:10.2519/jospt.2017.7469.
Topics: Adolescent; Age Factors; Child; Cognition Disorders; Communication; Humans; Infant; Musculoskeletal Pain; Pain Measurement; Parents; Referral and Consultation; Self Report
PubMed: 28918691
DOI: 10.2519/jospt.2017.7469 -
The Journal of Pain Jul 2024Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits... (Review)
Review
Through the Lens of Movement-Evoked Pain: A Theoretical Framework of the "Pain-Movement Interface" to Guide Research and Clinical Care for Musculoskeletal Pain Conditions.
Over 120 million Americans report experiencing pain in the past 3 months. Among these individuals, 50 million report chronic pain and 17 million report pain that limits daily life or work activities on most days (ie, high-impact chronic pain). Musculoskeletal pain conditions in particular are a major contributor to global disability, health care costs, and poor quality of life. Movement-evoked pain (MEP) is an important and distinct component of the musculoskeletal pain experience and represents an emerging area of study in pain and rehabilitation fields. This focus article proposes the "Pain-Movement Interface" as a theoretical framework of MEP that highlights the interface between MEP, pain interference, and activity engagement. The goal of the framework is to expand knowledge about MEP by guiding scientific inquiry into MEP-specific pathways to disability, high-risk clinical phenotypes, and underlying individual influences that may serve as treatment targets. This framework reinforces the dynamic nature of MEP within the context of activity engagement, participation in life and social roles, and the broader pain experience. Recommendations for MEP evaluation, encompassing the spectrum from high standardization to high patient specificity, and MEP-targeted treatments are provided. Overall, the proposed framework and recommendations reflect the current state of science in this emerging area of study and are intended to support future efforts to optimize musculoskeletal pain management and enhance patient outcomes. PERSPECTIVE: Movement-evoked pain (MEP) is a distinct component of the musculoskeletal pain experience and emerging research area. This article introduces the "Pain-Movement Interface" as a theoretical framework of MEP, highlighting the interface between MEP, pain interference, and activity engagement. Evaluating and treating MEP could improve rehabilitation approaches and enhance patient outcomes.
Topics: Humans; Musculoskeletal Pain; Movement
PubMed: 38316243
DOI: 10.1016/j.jpain.2024.01.351 -
Chiropractic & Manual Therapies Jun 2023This commentary closes the thematic series "A new paradigm for musculoskeletal pain care: moving beyond structural impairments". The papers published in the series point...
This commentary closes the thematic series "A new paradigm for musculoskeletal pain care: moving beyond structural impairments". The papers published in the series point to key aspects of shifting the paradigm of musculoskeletal care from clinician-led management often focused on addressing presumed structural anomalies to partnering with patients to find individual strategies that empower patients towards self-management. Several papers in the series highlighted the need for developing patient-centred models of care that respect individual patient's needs and preferences. Also, the series pointed to different options for modes of delivery including mHealth and the challenges and opportunities they present for developing person-centred strategies. For health care to provide effective support for people with musculoskeletal pain conditions, there is a need to recognise that contextual factors, including a strong patient-provider alliance, clearly play an important, perhaps primary, role. Health care professions dealing with musculoskeletal pain conditions should engage in research to investigate effective ways to move this understanding into practice including how to train providers. We hope the work collected in this series will stimulate further questions and more research as musculoskeletal pain providers seek to make their care more person-centred.
Topics: Humans; Musculoskeletal Pain; Chiropractic; Manipulation, Chiropractic; Musculoskeletal Manipulations
PubMed: 37264395
DOI: 10.1186/s12998-023-00484-2 -
Brazilian Journal of Anesthesiology... 2022Chronic pain is defined as a pain lasting more than 3-6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context.... (Review)
Review
INTRODUCTION
Chronic pain is defined as a pain lasting more than 3-6 months. It is estimated that 25% of the pediatric population may experience some kind of pain in this context. Adolescence, corresponding to a particular period of development, seems to present the ideal territory for the appearance of maladaptive mechanisms that can trigger episodes of persistent or recurrent pain.
METHODS
A narrative review, in the PubMed/Medline database, in order to synthetize the available evidence in the approach to chronic pain in adolescents, highlighting its etiology, pathophysiology, diagnosis, and treatment.
RESULTS
Pain is seen as a result from the interaction of biological, psychological, individual, social, and environmental factors. Headache, abdominal pain, and musculoskeletal pain are frequent causes of chronic pain in adolescents. Pain not only has implications on adolescents, but also on family, society, and how they interact. It has implications on daily activities, physical capacity, school performance, and sleep, and is associated with psychiatric comorbidities, such as anxiety and depression. The therapeutic approach of pain must be multimodal and multidisciplinary, involving adolescents, their families, and environment, using pharmacological and non-pharmacological strategies.
DISCUSSION AND CONCLUSION
The acknowledgment, prevention, diagnosis, and treatment of chronic pain in adolescent patients seem not to be ideal. The development of evidence-based forms of treatment, and the training of health professionals at all levels of care are essential for the diagnosis, treatment, and early referral of these patients.
Topics: Abdominal Pain; Adolescent; Analgesics, Opioid; Anxiety; Child; Chronic Pain; Humans; Musculoskeletal Pain
PubMed: 34153363
DOI: 10.1016/j.bjane.2021.04.033 -
British Journal of Clinical Pharmacology Jun 2019Disorders of the skeleton are frequently accompanied by bone pain and a decline in the functional status of the patient. Bone pain occurs following a variety of injuries... (Review)
Review
Disorders of the skeleton are frequently accompanied by bone pain and a decline in the functional status of the patient. Bone pain occurs following a variety of injuries and diseases including bone fracture, osteoarthritis, low back pain, orthopedic surgery, fibrous dysplasia, rare bone diseases, sickle cell disease and bone cancer. In the past 2 decades, significant progress has been made in understanding the unique population of sensory and sympathetic nerves that innervate bone and the mechanisms that drive bone pain. Following physical injury of bone, mechanotranducers expressed by sensory nerve fibres that innervate bone are activated and sensitized so that even normally non-noxious loading or movement of bone is now being perceived as noxious. Injury of the bone also causes release of factors that; directly excite and sensitize sensory nerve fibres, upregulate proalgesic neurotransmitters, receptors and ion channels expressed by sensory neurons, induce ectopic sprouting of sensory and sympathetic nerve fibres resulting in a hyper-innervation of bone, and central sensitization in the brain that amplifies pain. Many of these mechanisms appear to be involved in driving both nonmalignant and malignant bone pain. Results from human clinical trials suggest that mechanism-based therapies that attenuate one type of bone pain are often effective in attenuating pain in other seemingly unrelated bone diseases. Understanding the specific mechanisms that drive bone pain in different diseases and developing mechanism-based therapies to control this pain has the potential to fundamentally change the quality of life and functional status of patients suffering from bone pain.
Topics: Age Factors; Analgesics; Animals; Bone and Bones; Central Nervous System Sensitization; Chemoreceptor Cells; Humans; Longevity; Mechanoreceptors; Musculoskeletal Pain; Pain Perception; Pain Threshold; Quality of Life; Risk Factors; Sympathetic Nervous System
PubMed: 30357885
DOI: 10.1111/bcp.13801 -
Journal of Voice : Official Journal of... Nov 2019To investigate musculoskeletal pain, vocal fatigue, and voice-related quality of life of tele-operators and compare these aspects with nonvoice-related professionals;... (Observational Study)
Observational Study
OBJECTIVES
To investigate musculoskeletal pain, vocal fatigue, and voice-related quality of life of tele-operators and compare these aspects with nonvoice-related professionals; and verify if there is a relationship between musculoskeletal pain and vocal fatigue and voice-related quality of life (V-RQOL) of tele-operators and nonvoice-related professionals.
METHODS
Thirty-five tele-operators (SG) and 35 nonvoice-related professionals with no vocal complaints (control group) participated in the study. All of them answered investigating questionnaires of musculoskeletal pain, vocal fatigue index, and V-RQOL. The data were statistically analyzed in aim to compare the groups and the association between variables.
RESULTS
Women from SG presented higher pain frequency in their upper back than women from control group (P = 0.039). Different correlations were observed between musculoskeletal pain and vocal fatigue, just as between musculoskeletal pain and V-RQOLindex, for men and women in both groups. However, men presented a higher number or correlations between the protocols than women from both groups.
CONCLUSION
Female tele-operators presented higher pain frequency on their upper back when compared to nonvoice-related professional women. Musculoskeletal pain has a negative impact on voice-related quality of life and on the increase of vocal fatigue during oral communication, regardless of the professional use of the voice.
Topics: Advertising; Auditory Perception; Case-Control Studies; Dysphonia; Female; Humans; Job Description; Male; Musculoskeletal Pain; Occupational Diseases; Occupational Health; Occupations; Pain Measurement; Pain Perception; Predictive Value of Tests; Quality of Life; Risk Factors; Self Concept; Surveys and Questionnaires; Telephone; Voice Quality
PubMed: 30089538
DOI: 10.1016/j.jvoice.2018.07.006 -
The Journal of the American Academy of... Aug 2015Upper extremity pain can result from many overlapping etiologies. These can be categorized into anatomic regions and specific organ systems. Anatomically, pain... (Review)
Review
Upper extremity pain can result from many overlapping etiologies. These can be categorized into anatomic regions and specific organ systems. Anatomically, pain etiologies are classified into four major groups: neurologic, musculoskeletal, vascular, and other (eg, tumor, infection). Knowledge of the characteristic clinical presentation and physical examination findings of each group can help distinguish the source of the patient's complaints quickly so that an accurate clinical diagnosis can facilitate appropriate diagnostic measures and treatment. A focus on the neurologic causes of upper extremity pain (ie, cervical spine pathology, peripheral nerve compression, neuropathy) and musculoskeletal causes of shoulder and elbow pain (eg, adhesive capsulitis, calcific tendinitis, biceps tendinitis, synovitis) and the distinguishing characteristics (eg, periscapular pain, two-point discrimination, signal intensity on T2-weighted MRI) helps determine the appropriate diagnosis.
Topics: Arthralgia; Diagnosis, Differential; Humans; Musculoskeletal Pain; Physical Examination; Upper Extremity
PubMed: 26116851
DOI: 10.5435/JAAOS-D-11-00086