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PM & R : the Journal of Injury,... Dec 2020Nutrition is one of the most important lifestyle factors related to chronic diseases such as cancer, diabetes, and cardiovascular diseases. Additionally, poor diet is... (Review)
Review
Nutrition is one of the most important lifestyle factors related to chronic diseases such as cancer, diabetes, and cardiovascular diseases. Additionally, poor diet is also considered a predicting, perpetuating, or underlying factor in chronic musculoskeletal pain. This narrative review provides an overview of current knowledge on the relationship between nutrition and chronic musculoskeletal pain (ie, inflammation, obesity, homeostatic balance, and central sensitization as underlying mechanisms). This review also identifies how dietary intake assessments and nutritional behavior interventions for chronic musculoskeletal pain can be used in clinical practice and identifies areas in need of additional research. Based on the available literature, dietary behavior and quality could have an impact on chronic musculoskeletal pain conditions, but the direction of this impact is unclear. There is a need for additional human nutrition studies that focus on specific musculoskeletal pain conditions and underlying pathologies.
Topics: Central Nervous System Sensitization; Chronic Pain; Diet; Humans; Life Style; Musculoskeletal Pain; Nutritional Status; Obesity
PubMed: 32086871
DOI: 10.1002/pmrj.12346 -
JAMA Oncology May 2021The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain.
OBJECTIVE
To determine the effectiveness of electroacupuncture or auricular acupuncture for chronic musculoskeletal pain in cancer survivors.
DESIGN, SETTING, AND PARTICIPANTS
The Personalized Electroacupuncture vs Auricular Acupuncture Comparative Effectiveness (PEACE) trial is a randomized clinical trial that was conducted from March 2017 to October 2019 (follow-up completed April 2020) across an urban academic cancer center and 5 suburban sites in New York and New Jersey. Study statisticians were blinded to treatment assignments. The 360 adults included in the study had a prior cancer diagnosis but no current evidence of disease, reported musculoskeletal pain for at least 3 months, and self-reported pain intensity on the Brief Pain Inventory (BPI) ranging from 0 (no pain) to 10 (worst pain imaginable).
INTERVENTIONS
Patients were randomized 2:2:1 to electroacupuncture (n = 145), auricular acupuncture (n = 143), or usual care (n = 72). Intervention groups received 10 weekly sessions of electroacupuncture or auricular acupuncture. Ten acupuncture sessions were offered to the usual care group from weeks 12 through 24.
MAIN OUTCOMES AND MEASURES
The primary outcome was change in average pain severity score on the BPI from baseline to week 12. Using a gatekeeping multiple-comparison procedure, electroacupuncture and auricular acupuncture were compared with usual care using a linear mixed model. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care.
RESULTS
Among 360 cancer survivors (mean [SD] age, 62.1 [12.7] years; mean [SD] baseline BPI score, 5.2 [1.7] points; 251 [69.7%] women; and 88 [24.4%] non-White), 340 (94.4%) completed the primary end point. Compared with usual care, electroacupuncture reduced pain severity by 1.9 points (97.5% CI, 1.4-2.4 points; P < .001) and auricular acupuncture reduced by 1.6 points (97.5% CI, 1.0-2.1 points; P < .001) from baseline to week 12. Noninferiority of auricular acupuncture to electroacupuncture was not demonstrated. Adverse events were mild; 15 of 143 (10.5%) patients receiving auricular acupuncture and 1 of 145 (0.7%) patients receiving electroacupuncture discontinued treatments due to adverse events (P < .001).
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02979574.
Topics: Acupuncture, Ear; Adult; Cancer Survivors; Chronic Pain; Electroacupuncture; Female; Humans; Middle Aged; Musculoskeletal Pain; Neoplasms; Treatment Outcome
PubMed: 33734288
DOI: 10.1001/jamaoncol.2021.0310 -
The International Journal of Behavioral... Dec 2021Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions.
METHODS
Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review.
RESULTS
Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting.
CONCLUSIONS
We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases.
PROTOCOL REGISTRATION
PROSPERO ID # CRD42020166412 (Amended to limit the scope).
Topics: Adult; Cross-Sectional Studies; Humans; Leisure Activities; Musculoskeletal Pain; Sedentary Behavior; Workplace
PubMed: 34895248
DOI: 10.1186/s12966-021-01191-y -
British Journal of Sports Medicine Jul 2019
Review
Topics: Central Nervous System; Chronic Pain; Cognitive Behavioral Therapy; Exercise Therapy; Humans; Musculoskeletal Pain
PubMed: 29925503
DOI: 10.1136/bjsports-2017-098983 -
The Journal of Orthopaedic and Sports... Jun 2024We aimed to quantify the proportion not attributable to the specific effects (PCE) of physical therapy interventions for musculoskeletal pain. Intervention systematic... (Meta-Analysis)
Meta-Analysis Review
Which Portion of Physiotherapy Treatments' Effect Is Not Attributable to the Specific Effects in People With Musculoskeletal Pain? A Meta-Analysis of Randomized Placebo-Controlled Trials.
We aimed to quantify the proportion not attributable to the specific effects (PCE) of physical therapy interventions for musculoskeletal pain. Intervention systematic review with meta-analysis. We searched Ovid, MEDLINE, EMBASE, CINAHL, Scopus, PEDro, Cochrane Controlled Trials Registry, and SPORTDiscus databases from inception to April 2023. Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain. Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (RoB 2). The proportion of physical therapy interventions effect that was not explained by the specific effect of the intervention was calculated, using the proportion not attributable to the specific effects (PCE) metric, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method). Sixty-eight studies were included in the systematic review (participants: n = 5238), and 54 placebo-controlled trials informed our meta-analysis (participants: n = 3793). Physical therapy interventions included soft tissue techniques, mobilization, manipulation, taping, exercise therapy, and dry needling. Placebo interventions included manual, nonmanual interventions, or both. The proportion not attributable to the specific effects of mobilization accounted for 88% of the immediate overall treatment effect for pain intensity (PCE = 0.88, 95% confidence interval [CI]: 0.57, 1.20). In exercise therapy, this proportion accounted for 46% of the overall treatment effect for pain intensity (PCE = 0.46, 95% CI: 0.41, 0.52). The PCE in manipulation excelled in short-term pain relief (PCE = 0.81, 95% CI: 0.62, 1.01) and in mobilization in long-term effects (PCE = 0.86, 95% CI: 0.76, 0.96). In taping, the PCE accounted for 64% of disability improvement (PCE = 0.64, 95% CI: 0.48, 0.80). The outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by factors not attributable to the specific effects of the interventions. Boosting these factors consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients. .
Topics: Humans; Musculoskeletal Pain; Randomized Controlled Trials as Topic; Physical Therapy Modalities; Exercise Therapy
PubMed: 38602164
DOI: 10.2519/jospt.2024.12126 -
The Journal of Orthopaedic and Sports... Nov 2020Central sensitization is a physiological mechanism associated with enhanced sensitivity and pain responses. At present, central sensitization cannot be determined...
Central sensitization is a physiological mechanism associated with enhanced sensitivity and pain responses. At present, central sensitization cannot be determined directly in humans, but certain signs and symptoms may be suggestive of it. Although central sensitization has received increasing attention in the clinical literature, there is a risk that certain distinctions are being lost. This paper summarizes current knowledge of the physiology of central sensitization and its possible manifestations in patients, in order to inform a debate about the relevance of central sensitization for physical therapists. It poses 6 challenges associated with the application of central sensitization concepts in clinical practice and makes suggestions for assessment, treatment, and use of terminology. Physical therapists are asked to be mindful of central sensitization and consider potential top-down as well as bottom-up drivers, in the context of a person-centered biopsychosocial approach. .
Topics: Central Nervous System Sensitization; Humans; Musculoskeletal Pain; Patient-Centered Care; Physical Therapy Modalities; Terminology as Topic
PubMed: 33131390
DOI: 10.2519/jospt.2020.0610 -
Physiotherapy Theory and Practice Aug 2020To systematically determine the specific impact of therapeutic alliance (TA) on chronic musculoskeletal pain, identify factors influencing TA between physical therapists...
To systematically determine the specific impact of therapeutic alliance (TA) on chronic musculoskeletal pain, identify factors influencing TA between physical therapists and patients with chronic musculoskeletal pain, and determine the working definition of TA across studies. : Databases, including PubMed, CINHAL, and Embase, were searched from inception to January 2017. : The initial search resulted in 451 papers. After screening, seven studies were identified that examined the role of TA on chronic pain (> 12 weeks) management in physical therapy settings. : Authors extracted data into tables. Risk of bias was assessed using Cochrane Collaboration methodology. : Three studies examined the influence of a strong TA coupled with physical therapy on pain outcomes. Four studies identified factors that positively and negatively influenced TA. The working definition of TA was identified in each study. : Emerging evidence suggests that for individuals participating in physical therapy for chronic musculoskeletal pain, a strong TA may improve pain outcomes. In order to facilitate a strong TA, physical therapists must understand factors that positively and negatively influence the relationship. Studies demonstrate that the definition of TA remains consistent as it transitions to the physical therapy setting.
Topics: Humans; Musculoskeletal Pain; Physical Therapy Modalities; Therapeutic Alliance
PubMed: 30265840
DOI: 10.1080/09593985.2018.1516015 -
Physical Therapy Feb 2022Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain...
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
Topics: Avoidance Learning; Fear; Humans; Models, Psychological; Musculoskeletal Pain; Phobic Disorders; Safety
PubMed: 34971393
DOI: 10.1093/ptj/pzab271 -
The Journal of Bone and Joint Surgery.... Jul 2021There remains a lack of consensus regarding the treatment of Achilles insertional tendinopathy. The condition is typically treated with eccentric exercises despite the... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
There remains a lack of consensus regarding the treatment of Achilles insertional tendinopathy. The condition is typically treated with eccentric exercises despite the absence of satisfactory and sustained results. Shockwave therapy was presented as an alternative, but there is a paucity of literature, with good outcomes, supporting its use. The purpose of the present single-center, double-blinded, placebo-controlled, randomized trial was to determine if the use of shockwave therapy in combination with eccentric exercises improves pain and function in patients with Achilles insertional tendinopathy.
METHODS
A total of 119 patients with Achilles insertional tendinopathy were evaluated and enrolled in the study from February 2017 to February 2019. Patients were allocated to 1 of 2 treatment groups, eccentric exercises with extracorporeal shockwave therapy (SWT group) and eccentric exercises with sham shockwave therapy (control group). Three sessions of radial shockwaves (or sham treatment) were performed every 2 weeks and eccentric exercises were undertaken for 3 months. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the visual analogue scale, algometry, the Foot and Ankle Outcome Score, and the 12-Item Short Form Health Survey.
RESULTS
Both groups showed significant improvement during the study period; however, there were no between-group differences in any of the outcomes (all p >0.05). At the 24-week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (95% confidence interval, 8.0) compared with 62.3 (95% confidence interval, 6.9) in the control group (p = 0.876). There was a higher rate of failure (38.3%) but a lower rate of recurrence (17.0%) in the SWT group compared with the control group (11.5% and 34.6%, respectively; p = 0.002 and p = 0.047). There were no complications reported for either group.
CONCLUSIONS
Extracorporeal shockwave therapy does not potentiate the effects of eccentric strengthening in the management of Achilles insertional tendinopathy.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Achilles Tendon; Double-Blind Method; Exercise Therapy; Extracorporeal Shockwave Therapy; Female; High-Energy Shock Waves; Humans; Male; Middle Aged; Musculoskeletal Pain; Pain Measurement; Recurrence; Tendinopathy; Treatment Outcome
PubMed: 34029235
DOI: 10.2106/JBJS.20.01826 -
The Journal of Manual & Manipulative... Sep 2020To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention.
OBJECTIVES
To investigate the proportion of patients that present with isolated extremity pain who have a spinal source of symptoms and evaluate the response to spinal intervention.
METHODS
Participants (n = 369) presenting with isolated extremity pain and who believed that their pain was not originating from their spine, were assessed using a Mechanical Diagnosis and Therapy differentiation process. Numerical Pain Rating Scale, Upper Extremity/Lower Extremity Functional Index and the Orebro Questionnaire were collected at the initial visit and at discharge. Global Rating of Change outcomes were collected at discharge. Clinicians provided MDT 'treatment as usual'. A chi-square test examined the overall significance of the comparison within each region. Effect sizes between spinal and extremity source groups were calculated for the outcome scores at discharge.
RESULTS
Overall, 43.5% of participants had a spinal source of symptoms. Effect sizes indicated that the spinal source group had improved outcomes at discharge for all outcomes compared to the extremity source group.
DISCUSSION
Over 40% of patients with isolated extremity pain, who believed that their pain was not originating from the spine, responded to spinal intervention and thus were classified as having a spinal source of symptoms. These patients did significantly better than those whose extremity pain did not have a spinal source and were managed with local extremity interventions. The results suggest the spine is a common source of extremity pain and adequate screening is warranted to ensure the patients ́ source of symptoms is addressed.
Topics: Adult; Cohort Studies; Diagnosis, Differential; Disability Evaluation; Extremities; Female; Humans; Male; Middle Aged; Musculoskeletal Pain; Pain Measurement; Prevalence; Prospective Studies; Spine
PubMed: 31476129
DOI: 10.1080/10669817.2019.1661706