Chronic low back pain during COVID-19 lockdown: is there a paradox effect?

PURPOSE: The coronavirus 2019 (COVID-19) pandemic led to a compulsory lockdown of 3 months with strict restrictions. The impact of the COVID-19 pandemic has shown broad repercussions on patients with chronic pain; especially for conditions that present a significant emotional participation such as chronic low back pain (cLBP). METHODS: We performed a prospective study on 50 patients. Pre- and 1-month post-lockdown questionnaires such as: the Impact of Event Scale (IES), the Oswestry Disability Index (ODI), the Roland-Morris questionnaire (RMQ) and the visual analogue scale (VAS) for back and leg pain intensity were collected. RESULTS: The mean time of the evolution of cLBP was 33.04 months (range 5-120 months). Eighteen (36%) patients improved their cLBP (i-cLBP), whereas for 14 (28%) it was worse (w-cLBP). Cox multivariate proportional hazard model identified that MODIC 1 disc disease [OR 19.93, IC95% (2.81-102.13), p = 0.015] and at-home workouts [OR 18.854, IC95% (1.151-204.9), p = 0.040] were good prognosis factors of the improvement of cLBP while subclinical/mild Covid-19 anxiety (IES score < 26) was a poor prognosis factor in improving cLBP [OR 0.21, IC95% (0.001-0.384), p = 0.009]. Furthermore, pre-lockdown benzodiazepine medication [OR 2.554, IC95% (1.20-9.9), p = 0.002] was a prognosis factor of worse cLBP. In contrast, patients with severe Covid-19 anxiety (IES score > 26) significantly improved their cLBP [OR 0.58, IC95% (0.025-0.834), p = 0.01]. CONCLUSION: Lockdown affected the somatic component of cLBP by decreasing activities and physical measures, whereas the SARS-CoV-2 pandemic spectrum paradoxically improved the psychic and emotional component of cLBP.

[Work-related musculoskeletal disorders: priority to prevention and coordination of the interventions]. / Pathologies professionnelles musculo-squelettiques: priorité à la prévention et à la coordination des prises en charge.

Upper-limb musculoskeletal disorders (UL-MSDs) are painful conditions related to the overuse of periarticular soft tissues. The main UL-MSDs are rotator cuff tendinopathy, epicondylalgia, carpal tunnel syndrome and non-specific pain UL-MSDs are multifactorial disorders associated with individual and occupational (biomechanical, psychosocial and factors related to work organization) risk factors. Treatments are based on a global assessment of the clinical, social and occupational situations in order to identify cases of good prognosis and those, ess frequent, at high risk of prolonged work disability. The management of complex cases needs a close cooperation, with the agreement of the patient/worker, between the general practtioner and the occupational physician. One or more return to work visits are needed to help workers to keep their job. The prevention of UL-MSDs requires a global and integrated approach focusing on the reduction of the exposure to working constraints, early diagnosis and management and, if necessary, an intervention of stay at work. The new compensation procedures for UL-MSDs are described.

Evaluation of the efficacy, in terms of pain and disability, of a functional restoration programme in patients with chronic low back pain according to the presence of Modic 1 discopathy.

OBJECTIVES: Modic type 1 disc disease (MD1) appears to be related to severe Chronic Low Back Pain (CLBP). Functional Restoration Programmes (FRP) recommended in CLBP may not be suitable for patients with MD1. The main objective was to evaluate the effectiveness of a FRP, on the perceived incapacity and the pain intensity, in patients with non-specific CLBP according to the presence of MD1. METHODS: We performed a single-centre retrospective cohort study in which 271 patients were included. After one month in the FRP, this programme was considered "successful" if the pain visual analog scale had decreased by at least 20/100 millimetres and if the score of the French version of the Roland-Morris disability questionnaire had decreased by at least 4/24 points. RESULTS: The 271 patients had an average age of 43.2 (8.0) years and 58.3% were women. Out of our entire population, 128 (47.2%) patients were considered successful, and 51 (18.8%) patients had MD1. In patients without MD1, there was 49.1% success while this rate was 39.2% in those with MD1, but this difference was not statistically significant. CONCLUSIONS: We found no significant difference in the combination of pain and perceived disability after one month of a FRP in patients with CLBP without MD1 compared to those with CLBP with MD1. It therefore seems legitimate to offer FRP-type rehabilitation in patients with non-specific CLBP with MD1.

Validation of the General Health Questionnaire 12 for assessing psychological distress in patients with chronic low back pain.

BACKGROUND: The General Health Questionnaire 12 (GHQ-12) is a short easy-to-use scale to assess psychological distress. The GHQ-12 has not been validated for assessing psychological distress in patients with chronic low back pain (LBP). OBJECTIVE: To investigate the psychometric properties of the GHQ-12 in patients with chronic LBP. METHODS: The study involved a population of patients undergoing functional restoration for chronic LBP. The intraclass coefficient correlation was used for test-retest reliability (good if > 0.7) and the standard error measurement for absolute reliability. Construct validity was assessed with the Spearman correlation coefficient (moderate and high if r⩾ 0.35 and 0.5, respectively) and internal consistency with Cronbach's alpha (suitable if > 0.7). Responsiveness was assessed by the Wilcoxon test and effect size. RESULTS: Four hundred and five patients were included. The intraclass coefficient correlation was 0.73 and standard error measurement 2.49. The GHQ-12 showed high convergence with the Beck Depression Inventory and subscales of the Dallas Pain Questionnaire for anxiety and depression and for sociability. It showed moderate convergence with the Quebec Back Pain Disability Scale and subscales of the Dallas Pain Questionnaire for daily activities and for leisure and occupation. Cronbach's alpha was 0.89. The GHQ-12 score changed after functional restoration. It was lower (better) with than without improvement. CONCLUSIONS: We provide validation of the GHQ-12 for assessing psychological distress in patients with chronic LBP.

Thoracic outlet syndrome: definition, aetiological factors, diagnosis, management and occupational impact.

INTRODUCTION: Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment. METHOD, RESULTS AND CONCLUSION: The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.

2020 French recommendations on the management of septic arthritis in an adult native joint.

Septic arthritis (SA) in an adult native joint is a rare condition but a diagnostic emergency due to the morbidity and mortality and the functional risk related to structural damage. Current management varies and the recommendations available are dated. The French Rheumatology Society (SFR) Bone and Joint Infection Working Group, together with the French Language Infectious Diseases Society (SPILF) and the French Orthopaedic and Trauma Surgery Society (SOFCOT) have worked according to the HAS methodology to devise clinical practice recommendations to diagnose and treat SA in an adult native joint. One new focus is on the importance of microbiological documentation (blood cultures and joint aspiration) before starting antibiotic treatment, looking for differential diagnoses (microcrystal detection), the relevance of a joint ultrasound to guide aspiration, and the indication to perform a reference X-ray. A cardiac ultrasound is indicated only in cases of SA involving Staphylococcus aureus, oral streptococci, Streptococcus gallolyticus or Enterococcus faecalis, or when infective endocarditis is clinically suspected. Regarding treatment, we stress the importance of medical and surgical collaboration. Antibiotic therapies (drugs and durations) are presented in the form of didactic tables according to the main bacteria in question (staphylococci, streptococci and gram-negative rods). Probabilistic antibiotic therapy should only be used for patients with serious symptoms. Lastly, non-drug treatments such as joint drainage and early physical therapy are the subject of specific recommendations.

Pure proximal deletion of chromosome 21 and kyphosis.

We report on two unrelated patients with a proximal deletion of the long arm of chromosome 21. The deletion encompassed 14.5Mb of DNA. Molecular studies showed that the two telomeric breakpoints were within the same DNA clone (BAC RP11-56D12). The centromeric breakpoints, however, were separated by only 250kb of DNA (BAC RP11-645E14 and RP11-324B9). The phenotype observed in the two patients was very different, as patient 2, who had the largest deletion, had severe kyphosis not observed in patient 1. Previous studies have identified a 6Mb region of chromosome 21 associated with severe kyphosis. Interestingly, this region overlaps the 250kb segment deleted in patient 2. We suggest that one gene (NT011512.4) located in this small overlapping region might be responsible for severe kyphosis.

Visceral obesity and chronic pain: effect of a 4-week rehabilitation program on adipokines and insulin resistance.

Obesity and chronic pain are two major diseases of the 21th century. Our principal objective was to investigate the effects of a 4-week rehabilitation program on adiponectin and leptin concentrations, and insulin resistance, in patients with abdominal obesity and chronic pain syndrome. Our secondary objectives were to investigate the effects of this program on pain, body mass index (BMI), waist circumference and maximal oxygen consumption (VO2max) and to compare changes in VO2max between patients with or without insulin resistance. Among a consecutive sample of 128 patients with abdominal obesity hospitalized for rehabilitation for a chronic pain syndrome, 111 completed the protocol, which was a 4-week rehabilitation program including 6 hr of rehabilitation per day, 5 days per week, in a referral center of rehabilitation. This prospective cohort study compared clinical (BMI, waist circumference, VO2max, pain) and biological measures (concentrations of adiponectin, leptin and insulin, score of homeostasis model assessment of insulin resistance [HOMA]) before and after the program. Plasma leptin, adiponectin and insulin concentrations (P<0.0001) and score of HOMA (P=0.0002) had decreased significantly by the end of the 4 weeks. Pain, BMI and waist circumference decreased significantly, and VO2max improved significantly (P=0.0001). Patients with insulin resistance had less improvement of their aerobic condition at the end of the 4 weeks (P<0.002). The rehabilitation program decreases the concentration of leptin, and improves insulin sensitivity in patients with chronic pain and visceral obesity. Aerobic recovery was worse for patients with insulin resistance than other patients.

Clinical examination as a tool for identifying the origin of regional musculoskeletal pain.

A knowledge of the physiopathology of the processing of noxious stimuli in regional musculoskeletal disorders is useful for an understanding of the clinical history. In regional musculoskeletal pain (RMP) the physiopathology of the pain may be separated into two main features. First, the nociceptive pain which results from the activation of nociceptors diffusely distributed among the anatomical structures in and around the joint, apart from the cartilage; the nociceptive pain has a protective role. Second, the abnormal impulses from a nervous tissue lesion give rise to a neuropathic pain which offers no biological advantage and is a maladaptive pain. This chapter describes the main physiological characteristics of these two kinds of pain. From these, in the majority of cases, the clinical history and the physical examination must specify the diagnosis of the RMP and localize the source of pain. Furthermore, the clinical characteristics permit diagnosis of different complex situations where these two types of pain are associated.