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Medicine Nov 2023Acupuncture has been widely used for chronic musculoskeletal pain syndrome (MPS). Due to the strong influence of sham acupuncture (SA) in clinical trials, the treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acupuncture has been widely used for chronic musculoskeletal pain syndrome (MPS). Due to the strong influence of sham acupuncture (SA) in clinical trials, the treatment of MPS by acupuncture remains controversial. Different types of SA procedures might produce different responses. The purpose of this systematic review was to assess the effect of SA on MPS.
METHODS
We searched 8 literature databases for randomized controlled trials (RCTs) on acupuncture for chronic MPS with SA as a control from database inception to November 29, 2022. SA included superficial acupuncture on non-acupoints (SANAs), non-penetration on acupoints (NPAs), and non-penetration on non-acupoints (NPNAs). Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. We conducted data analysis using the RevMan 5.3 and STATA 14 software packages, and traditional meta-analysis was adopted for direct comparison. A network meta-analysis (NMA) was executed using frequency models in which we combined all available direct and indirect evidence from RCTs. The pain-related indicators were set as primary outcomes, and GRADEpro online was implemented for the assessment of evidence quality.
RESULTS
Forty-two RCTs were included in this study, encompassing a total of 6876 patients and incorporating 3 types of SA procedures. In our traditional meta-analysis, true acupuncture (TA) was more effective than SANAs, NPAs, and NPANAs concerning MPS. In the NMA, TA was the most effective modality, followed by SANAs, NPAs and NPANAs, and then the blank control (BC). In this NMA and according to the therapeutic effects in the pain indicators, the rankings of SA were as follows: SANA (surface under the cumulative ranking curve [SUCRA], 65.3%), NPA (SUCRA, 46.2%), and NPANA (SUCRA, 34.2%). The quality of the evidence for outcomes ranged from "low" to "moderate."
CONCLUSIONS
Compared with SA, TA was effective in treating MPS. The effects produced by different SA procedures were different, and the order of effects from greatest to least was as follows: SANA, NPA, and NPANA.
Topics: Humans; Musculoskeletal Pain; Network Meta-Analysis; Randomized Controlled Trials as Topic; Chronic Pain; Acupuncture Therapy; Syndrome; Rheumatic Diseases
PubMed: 37986368
DOI: 10.1097/MD.0000000000035275 -
Scientific Reports Jul 2023This study determined if 18 days of supplementation with blueberries (BL) compared to placebo (PL) could mitigate muscle soreness and damage and improve inflammation... (Randomized Controlled Trial)
Randomized Controlled Trial
This study determined if 18 days of supplementation with blueberries (BL) compared to placebo (PL) could mitigate muscle soreness and damage and improve inflammation resolution in untrained adults (n = 49, ages 18-50 years) after engaging in a 90-min bout of "weekend warrior" eccentric exercise. The BL freeze dried supplement provided 1 cup of fresh blueberries per day equivalent with 805 mg/day total phenolics and 280 mg/day anthocyanins. Urine levels of eight BL gut-derived phenolics increased after 14- and 18-days supplementation with 83% higher concentrations in BL vs. PL (p < 0.001). The 90-min exercise bout caused significant muscle soreness and damage during 4d of recovery and a decrease in exercise performance with no significant differences between PL and BL. Plasma oxylipins were identified (n = 76) and grouped by fatty acid substrates and enzyme systems. Linoleic acid (LA) oxylipins generated from cytochrome P450 (CYP) (9,10-, 12,13-dihydroxy-9Z-octadecenoic acids) (diHOMEs) were lower in BL vs. PL (treatment effect, p = 0.051). A compositive variable of 9 plasma hydroxydocosahexaenoic acids (HDoHEs) generated from docosahexaenoic acid (DHA, 22:6) and lipoxygenase (LOX) was significantly higher in BL vs. PL (treatment effect, p = 0.008). The composite variable of plasma 14-HDoHE, 17-HDoHE, and the eicosapentaenoic acid (EPA)-derived oxylipin 18-hydroxyeicosapentaenoic acid (18-HEPE) (specialized pro-resolving lipid mediators, SPM, intermediates) was significantly higher in BL vs PL (treatment effect, p = 0.014). Pearson correlations showed positive relationships between post-exercise DHA-LOX HDoHEs and SPM intermediates with urine blueberry gut-derived phenolics (r = 0.324, p = 0.023, and r = 0.349, p = 0.015, respectively). These data indicate that 18d intake of 1 cup/day blueberries compared to PL was linked to a reduction in pro-inflammatory diHOMES and sustained elevations in DHA- and EPA-derived anti-inflammatory oxylipins in response to a 90-min bout of unaccustomed exercise by untrained adults.
Topics: Adult; Humans; Oxylipins; Anthocyanins; Blueberry Plants; Myalgia; Anti-Inflammatory Agents; Docosahexaenoic Acids; Eicosapentaenoic Acid
PubMed: 37488250
DOI: 10.1038/s41598-023-39269-1 -
Preventive Medicine Sep 2023Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study...
Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study aimed to determine the prospective association between musculoskeletal pain intensity and risk of incident register-based long-term sickness absence in the general working population, as well as to determine the population attributable fraction. Drawing on data from a nation-wide questionnaire survey, this prospective cohort study followed a representative sample of the Danish general working population without recent long-term sickness absence (≥6 consecutive weeks) (n = 69,273) for long-term sickness absence up to two years (mean follow-up: 93 weeks) in a national register. The predictor was musculoskeletal pain intensity in the neck/shoulder and low-back during the preceding three months rated on an 11-point numerical rating scale from 0 to 10. The weighted incidence of long-term sickness-absence was 8.9% during two-year follow-up (n = 6165). We observed a clear dose-response association between musculoskeletal pain intensity of the neck/shoulder or low-back and the risk of incident long-term sickness absence, with a lower threshold of increased risk of 4 and 3 (scale 0-10) for neck/shoulder (HR (95% CI): 1.25 (1.09-1.42)) and low-back pain (HR (95% CI): 1.13 (1.00-1.29)), respectively. Prevention of pain intensities at or above 4 out of 10 could potentially prevent 17% (population attributable fraction, PAF (95% CI): 16.8 (13.6-20.1)) of the total long-term sickness absence in the general working population. Large-scale interventions to prevent and manage musculoskeletal pain need to be documented and implemented.
Topics: Humans; Musculoskeletal Pain; Follow-Up Studies; Prospective Studies; Pain Measurement; Low Back Pain; Sick Leave; Absenteeism
PubMed: 37473925
DOI: 10.1016/j.ypmed.2023.107636 -
Rheumatology (Oxford, England) Sep 2023This systematic review and meta-analysis synthesizes the evidence on prospective bidirectional associations between sleep-related problems (SRP) and chronic... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis synthesizes the evidence on prospective bidirectional associations between sleep-related problems (SRP) and chronic musculoskeletal pain (CMP).
METHODS
A literature search for cohort studies available in the PubMed, Scopus, Web of Science, PsycINFO and Cochrane Library databases as of 19 July 2022 was performed. Pooled odds ratios and effect sizes were calculated through random effects meta-analysis. Subgroup and meta-regression analyses were performed to explore differences by follow-up time, proportion of each sex and mean age. The Meta-analysis Of Observational Studies in Epidemiology guidelines were strictly followed.
RESULTS
Twenty studies with a total of 208 190 adults (aged 34.4-71.7 years) were included, with 17 of them being used in the meta-analysis. Individuals with SRP at baseline had a 1.79-fold higher incidence (odds ratio [OR] = 1.79; 95% CI: 1.55, 2.08; I2 = 84.7%; P < 0.001) and a 2.04-fold higher persistence (OR = 2.04; 95% CI: 1.42, 2.94; I2 = 88.5%; P < 0.005) of CMP than those without SRP. In the subgroup analysis of the association between SRP and CMP, the longer the follow-up time of the studies, the higher the heterogeneity between them. In the corresponding meta-regression, no significant effect was observed for follow-up time, sex proportion or age. Individuals with CMP at baseline had a 2.02-fold higher incidence of SRP (OR = 2.02; 95% CI: 1.62, 2.53; I2 = 90.0%; P < 0.001) than those without CMP.
CONCLUSION
This study provides robust evidence concerning the longitudinal association between SRP and incidence-persistence of CMP in adults. In addition, the available prospective studies support the existence of a bidirectional relationship between CMP and SRP.
PROSPERO REGISTRATION NUMBER
CRD42020212360.
Topics: Adult; Humans; Prospective Studies; Musculoskeletal Pain; Sleep; Cohort Studies
PubMed: 37104741
DOI: 10.1093/rheumatology/kead190 -
The burden of musculoskeletal pain, associated sociodemographic factors, and disability in Pakistan.International Journal of Rheumatic... Jan 2024The objective of this survey was to determine the burden of musculoskeletal (MSK) pain, its association with sociodemographic factors and disability in the semi-urban...
OBJECTIVE
The objective of this survey was to determine the burden of musculoskeletal (MSK) pain, its association with sociodemographic factors and disability in the semi-urban community of Nain-Sukh, Lahore.
METHODS
The current article's data is taken from the COPCORD survey conducted in the community of Nain-Sukh. After formal IRB approval, data collection was done via interview by a trained team using validated Urdu translation of COPCORD core questionnaires. Participants of both genders, >16 years, were enrolled through a random walk and quota sampling. In phase 1, sociodemographic factors were recorded. In phase 2, the impact of MSK pain on functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ). The data was compiled and analyzed using software SPSS version 25. The Chi-square test was applied to determine association while generalized linear regression models to see the dependence of sociodemographic factors and MSK pain.
RESULTS
Out of 4922 participants, 1425 (28.9%) had MSK pain, with a mean age of 35 ± 14 years, with female predominance. Illiteracy, marital status, and household work with moderate intensity were significantly associated with MSK pain. Based on the MHAQ score, the majority 769 (82.9%) had a mild disability. Odds of advancing age, illiteracy, and moderate intensity of work were statistically significant for MSK pain.
CONCLUSION
Every fourth subject in the surveyed population had MSK pain. Musculoskeletal pain was found to be significantly associated with female gender, advancing age, household work, illiteracy, married status, and moderate nature of work. More than two-thirds of the subjects with MSK pain had some degree of disability.
Topics: Humans; Male; Female; Young Adult; Adult; Middle Aged; Musculoskeletal Pain; Pakistan; Sociodemographic Factors; Surveys and Questionnaires; Musculoskeletal Diseases; Azides; Mitoxantrone; Norepinephrine
PubMed: 37997543
DOI: 10.1111/1756-185X.14972 -
Seminars in Musculoskeletal Radiology Dec 2023Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown.... (Review)
Review
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
Topics: Humans; Knee Joint; Magnetic Resonance Imaging; Synovitis; Musculoskeletal Pain; Inflammation; Molecular Imaging
PubMed: 37935208
DOI: 10.1055/s-0043-1775741 -
European Review For Medical and... Dec 2023In patients with breast cancer and positive hormone receptors, aromatase inhibitors are effective in reducing the risk of recurrences and are active in progressing the...
OBJECTIVE
In patients with breast cancer and positive hormone receptors, aromatase inhibitors are effective in reducing the risk of recurrences and are active in progressing the disease in this setting. On the other hand, fatigue and painful musculoskeletal side effects can significantly reduce treatment compliance. With no further treatment options to control these symptoms, non-pharmaceutical interventions, such as oxygen-ozone therapy, may play a role in managing rheumatologic symptomatology inasmuch. We have previously reported evidence on the effectiveness of oxygen-ozone in the treatment of pain and fatigue in chronic fatigue syndrome and fibromyalgia patients and in oncological patients as well.
PATIENTS AND METHODS
In this study, we reported 6 cases of patients (mean age 64 yrs, all Caucasian females) with breast cancer upon treatment with anastrozole (Arimidex®), suffering from musculoskeletal pain, weakness and fatigue, and therefore treated with oxygen-ozone major autohemotherapy according to the Italian Scientific Society of Oxygen Ozone Therapy (SIOOT) protocol. Pain was measured with a 10-item Numerical Rating Scale (NRS) and fatigue with a 7-item Fatigue Scoring Scale (FSS).
RESULTS
A reduction of at least 66% of pain (from 9.43 ±0.54 SD to 2.36 ±1.32 SD, p<0.001) and 66.26% of fatigue were obtained for all the cases. Pain and fatigue disappeared within one month from ozone therapy, and a healthy painless state lasted for many months following the oxygen-ozone therapy.
CONCLUSIONS
The oxygen-ozone therapy is a sound opportunity for breast cancer patients to reduce anti-aromatase-induced pain, fatigue, and musculoskeletal symptoms.
Topics: Female; Humans; Middle Aged; Aromatase Inhibitors; Breast Neoplasms; Musculoskeletal Pain; Ozone; Quality of Life; Oxygen; Anastrozole
PubMed: 38095411
DOI: 10.26355/eurrev_202312_34602 -
Aging Clinical and Experimental Research May 2024Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.
BACKGROUND
Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.
OBJECTIVE
To examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.
DESIGN
We used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).
PARTICIPANTS
A total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.
METHODS
Group-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.
RESULTS
Persons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.
CONCLUSIONS
Persons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.
Topics: Humans; Musculoskeletal Pain; Male; Aged; Female; Activities of Daily Living; Independent Living; Disabled Persons; Aged, 80 and over; Disability Evaluation
PubMed: 38780859
DOI: 10.1007/s40520-024-02764-0 -
Annals of Internal Medicine Oct 2023Beyond initial COVID-19 pandemic emergency expansions of telemedicine use, it is unclear how well primary care telemedicine addresses patients' needs. (Comparative Study)
Comparative Study
BACKGROUND
Beyond initial COVID-19 pandemic emergency expansions of telemedicine use, it is unclear how well primary care telemedicine addresses patients' needs.
OBJECTIVE
To compare treatment and follow-up visits (office, emergency department, hospitalization) between primary care video or telephone telemedicine and in-person office visits.
DESIGN
Retrospective design based on administrative and electronic health record (EHR) data.
SETTING
Large, integrated health care delivery system with more than 1300 primary care providers, between April 2021 and December 2021 (including the COVID-19 pandemic Delta wave).
PATIENTS
1 589 014 adult patients; 26.5% were aged 65 years or older, 54.9% were female, 22.2% were Asian, 7.4% were Black, 22.3% were Hispanic, 46.5% were White, 21.5% lived in neighborhoods with lower socioeconomic status, and 31.8% had a chronic health condition.
MEASUREMENTS
Treatment outcomes included medication or antibiotic prescribing and laboratory or imaging ordering. Follow-up visits included in-person visits to the primary care office or emergency department or hospitalization within 7 days. Outcomes were adjusted for sociodemographic and clinical characteristics overall and stratified by clinical area (abdominal pain, gastrointestinal concerns, back pain, dermatologic concerns, musculoskeletal pain, routine care, hypertension or diabetes, and mental health).
RESULTS
Of 2 357 598 primary care visits, 50.8% used telemedicine (19.5% video and 31.3% telephone). After adjustment, medications were prescribed in 46.8% of office visits, 38.4% of video visits, and 34.6% of telephone visits. After the visit, 1.3% of in-person visits, 6.2% of video visits, and 7.6% of telephone visits had a 7-day return in-person primary care visit; 1.6% of in-person visits, 1.8% of video visits, and 2.1% of telephone visits were followed by an emergency department visit. Differences in follow-up office visits were largest after index office versus telephone visits for acute pain conditions and smallest for mental health.
LIMITATIONS
In the study setting, telemedicine is fully integrated with ongoing EHRs and with clinicians, and the study examines an insured population during the late COVID-19 pandemic period. Observational comparison lacks detailed severity or symptom measures. Follow-up was limited to 7 days. Clinical area categorization uses diagnosis code rather than symptom.
CONCLUSION
In-person return visits were somewhat higher after telemedicine compared with in-person primary care visits but varied by specific clinical condition.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Adult; Female; Humans; Male; COVID-19; Follow-Up Studies; Musculoskeletal Pain; Pandemics; Primary Health Care; Retrospective Studies; Telemedicine
PubMed: 37844311
DOI: 10.7326/M23-1335 -
Medicina (Kaunas, Lithuania) Dec 2023: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women... (Meta-Analysis)
Meta-Analysis Review
: To identify the most frequently reported predictive factors for the persistency of pregnancy-related pelvic girdle pain (PPGP) at 3-6 months after childbirth in women with PPGP alone or PPGP in association with pregnancy-related lower back pain (PLBP). : Eligibility criteria: Two authors independently selected studies excluding PPGP determined by a specific, traumatic, gynecological/urological cause or isolated PLBP and studies that did not include the presence/absence of PPGP as the the primary outcome. We, instead, included studies with an initial assessment in pregnancy (within 1 month of delivery) and with a follow-up of at least 3 months after delivery. : The research was performed using the databases of Medline, Cochrane, Pedro, Scopus, Web of Science and Cinahl from December 2018 to January 2022, following the indications of the PRISMA statement 2021 and the MOOSE checklist. It includes observational cohort studies in which data were often collected through prospective questionnaires (all in English). : Two independent authors performed evaluations of the risk of bias (ROB) using the quality in prognostic studies (QUIPS) tool. : An in-depth qualitative analysis was conducted because, due to a high degree of heterogeneity in the data collection of the included studies and a lack of raw data suitable for quantitative analysis, it was not possible to carry out the originally planned meta-analyses for the subgroups. : The research process led to the inclusion of 10 articles which were evaluated using the QUIPS tool: 5 studies were evaluated as low ROB and 5 were evaluated as moderate ROB. High levels of pain in pregnancy, a large number of positive provocation tests, a history of lower back pain and lumbo-pelvic pain, high levels of disability in pregnancy, neurotic behavior and high levels of fear-avoidance belief were identified as strong predictors of long-term PPGP, while there was weak or contradictory evidence regarding predictions of emotional distress, catastrophizing and sleep disturbances. : The impossibility of carrying out the meta-analysis by subgroups suggests the need for further research with greater methodological rigor in the acquisition of measures based on an already existing PPGP core predictors/outcome sets.
Topics: Pregnancy; Humans; Female; Pelvic Girdle Pain; Low Back Pain; Prospective Studies; Pregnancy Complications; Surveys and Questionnaires
PubMed: 38138226
DOI: 10.3390/medicina59122123