Cognitive behavioral therapy for insomnia in people with chronic musculoskeletal pain. A systematic review and dose-response meta-analysis.

The aims were (i) to determine the effects of Cognitive behavioral therapy for insomnia (CBT-I) on sleep disturbances, pain intensity and disability in patients with chronic musculoskeletal pain (CMP), and (ii) to determine the dose-response association between CBT-I dose (total minutes) and improvements in sleep disorders, pain intensity and disability in patients with CMP. A comprehensive search was conducted in PubMed/MEDLINE, Web of Science, CINAHL, and SCOPUS until December 17, 2023. Randomized clinical trials (RCTs) using CBT-I without co-interventions in people with CMP and sleep disorders were eligible. Two reviewers independently extracted data and assessed risk of bias and certainty of the evidence. A random effects meta-analysis was applied to determine the effects on the variables of interest. The dose-response association was assessed using a restricted cubic spline model. Eleven RCTs (n = 1801 participants) were included. We found a significant effect in favor of CBT-I for insomnia (SMD: -1.34; 95%CI: -2.12 to -0.56), with a peak effect size at 450 min of CBT-I (-1.65, 95%CI: -1.89 to -1.40). A non-significant effect was found for pain intensity. A meta-analysis of disability was not possible due to the lack of data. This review found benefits of CBT-I for insomnia compared to control interventions, with a large effect size. In addition, it was estimated that a 250-min dose of CBT-I had a large effect on reducing insomnia and that the peak effect was reached at 450 min. These novel findings may guide clinicians in optimizing the use of CBT-I in people with CMP and insomnia.

Sedentary behavior is associated with musculoskeletal pain in adolescents: A cross sectional study.

BACKGROUND: High prevalence of back pain has been observed in adolescents. Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. The association between back pain and SB in the pediatric/adolescent population is not well established. OBJECTIVE: To investigate the association between SB and low back and neck pain in adolescents according to sex. METHODS: This is a cross-sectional study with children and adolescents aged 10-17 years, randomly recruited from public and private schools in Presidente Prudente, Brazil. All students enrolled in the selected schools were eligible to participate. SB was evaluated by adding the number of hours of use of screen devices, such as television, computer, video game, and smartphone/tablet. To assess neck and low back pain, the Nordic Musculoskeletal Questionnaire was used. Physical activity and socioeconomic status were assessed by the Baecke Questionnaire and the Brazilian Criteria for Economic Classification (ABEP), respectively. Odds ratio (OR) from Binary Logistic Regression in the unadjusted and adjusted model (physical activity, abdominal obesity, and socioeconomic status) showed the relationship between musculoskeletal pain and SB. RESULTS: A total of 1011 adolescents (557 girls) with a mean ± standard deviation age of 13.2±2.4 years were included. Moderate (OR = 1.80; 95%CI: 1.00, 3.23) and high (OR = 1.91; 95%CI: 1.02, 3.53) SB were associated with neck pain in girls. In boys, moderate SB (OR = 2.75; 95%CI: 1.31, 5.78) were associated with neck pain. Moderate (OR = 2.73; 95%CI: 1.45, 5.02) and high (OR = 2.49; 95%CI: 1.30, 4.76) SB were associated with low back pain only in girls. CONCLUSION: Moderate and high SB were associated with neck pain in girls and boys, while moderate and high SB were associated with low back pain only in girls.

Scurvy Masquerading as Juvenile Idiopathic Arthritis or Vasculitis with Elevated Inflammatory Markers: A Case Series.

Ten patients with scurvy were evaluated by rheumatology; we review their clinical, laboratory, and dietary presentations. Eight patients had developmental delay or autism. All had elevated inflammatory markers. These clinical and laboratory features with imaging findings can mimic rheumatic conditions such as arthritis, vasculitis, and chronic nonbacterial osteomyelitis (CNO).

Physical and psychological predictors on pain intensity in conscripts with plantar fasciitis.

BACKGROUND: Plantar fasciitis is commonly found among the physically active population, including conscripts. Some studies have reported that being overweight and having psychological symptoms contribute to pain from plantar fasciitis. However, there is a lack of information regarding the physical predictors, and more research is needed to determine the relationship between such predictors and pain intensity from plantar fasciitis in conscripts. OBJECTIVE: To determine which physical and psychological variables act as predictors of pain intensity among Thai novice conscripts with plantar fasciitis. METHODS: Two hundred and seventy Thai novice conscripts without musculoskeletal pain completed the Depression, Anxiety and Stress Scale short version and then received baseline assessment of ankle dorsiflexion angle, ankle plantarflexor strength, and quality of lower extremity movement from a physical therapist. After 10 weeks of military training, 71 of these Thai conscripts developed pain from plantar fasciitis. Multiple linear regression analysis with the forward stepwise method was used to explore the predictors of pain intensity due to plantar fasciitis. RESULTS: Using a forward regression analysis, anxiety (B=0.13; 95% CI, 0.06-0.20; p<0.01) and quality of movement score (B=0.87; 95% CI, 0.28-1.47; p=0.01) were significant predictors of pain intensity. The regression model with these predictors explained 25% of the variability in pain intensity from plantar fasciitis. CONCLUSION: Higher scores of anxiety and movement quality on the lateral step-down task were associated with pain intensity from plantar fasciitis after the completion of a 10-week military program. However, lower ankle dorsiflexion angle and ankle plantarflexor strength did not predict pain intensity.

Does low and heavy load resistance training affect musculoskeletal pain in overweight and obese women? Secondary analysis of a randomized controlled trial.

BACKGROUND: Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints. OBJECTIVE: The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs. METHODS: This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18-65) with a BMI (kg/m2) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n=24), heavy load resistance training with a personal trainer (n=28), non-supervised heavy load resistance training (n=19) or non-exercising controls (n=21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n=38) and low (≤27 of 36 sessions, n=22) exercise adherence. RESULTS: The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence. CONCLUSIONS: Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women. CLINICAL TRIAL REGISTRATION NUMBER: NCT01993953. (https://clinicaltrials.gov/ct2/show/NCT01993953).

Musculoskeletal Pain and Voice-related Quality of Life in Dysphonic and Non-dysphonic Subjects.

PURPOSE: This study aimed to compare and correlate musculoskeletal pain and voice-related quality of life of dysphonic and non-dysphonic individuals. METHOD: This is a retrospective case-control study. A total of 74 adults were divided into two groups: the experimental group (EG) comprising 37 individuals with vocal complaints and hyperfunctional dysphonia, and the control group (CG) comprising 37 individuals without vocal complaints and with healthy voices. Both groups presented similar gender and age (28 females and 9 males for each group; average age = 31.5). All the participants answered the protocols: Voice-Related Quality of Life and Musculoskeletal Pain Questionnaire. Statistical data were analyzed by Mann-Whitney U test (P ≤ 0.05) and Spearman correlation test (P ≤ 0.05). RESULTS: It was observed that the EG presented significantly lower scores of voice-related quality of life in the social-emotional (P < 0.001), physical (P < 0.001), and total (P < 0.001) fields. Concerning musculoskeletal pain, it was observed in the EG that there was a higher intensity in pain in the region of the larynx (P < 0.001), and a higher frequency of pain in the submandibular (P = 0.013), larynx (P < 0.001), and front of the neck (P = 0.002) regions, when compared with the CG. CONCLUSION: In the group of individuals studied, worst indexes of voice-related quality of life and higher frequency and intensity of pain in the larynx were observed, in addition to higher frequency of pain in regions near the larynx in dysphonic subjects. There was correlation between voice-related quality of life and the frequency and intensity of musculoskeletal pain.

A case-control study about bite force, symptoms and signs of temporomandibular disorders in patients with idiopathic musculoskeletal pain syndromes.

BACKGROUND: The purposes of this study were to assess the prevalence of temporomandibular disorders symptoms and signs and the bite force in pediatric patients with idiopathic musculoskeletal pain syndrome and to compare to healthy control individuals paired by gender and age. METHODS: Forty consecutive patients (32 girls) from our outpatient pediatric rheumatology pain clinic with diagnosis of idiopathic musculoskeletal pain syndrome were included in this study. Twenty healthy subjects (16 girls) were considered the control group. All individuals were interviewed according to a standardized questionnaire concerning the presence of orofacial pain and functional impairment, and were submitted to a clinical evaluation following a structured protocol. After that the bite force was measured. RESULTS: Twelve patients met the ACR criteria for fibromyalgia, and 28 presented the diagnosis of pain amplification syndrome. The mean age of patients was 13.1 years (range, 6-18 years) and of controls was 12.8 years (range, 6-18 years) with no significant difference. Orofacial symptoms occurred in 25 patients (62.5%) and in 3 controls (15%) (p = 0.0014). Sixteen (40%) patients and four (20%) controls presented pain during mandibular function with no significant difference. Although both pain groups presented separately more frequently orofacial symptoms and pain on palpation than the controls, maximal voluntary bite force was similar between patients and controls, between both patient groups and between the two pain groups and controls. CONCLUSIONS: Our findings indicate that temporomandibular disorders symptoms were more prevalent in patients with idiopathic musculoskeletal pain syndrome than in healthy controls. However the bite force was not different among the groups.

Anti-hyperalgesic effect of Lippia grata leaf essential oil complexed with ß-cyclodextrin in a chronic musculoskeletal pain animal model: Complemented with a molecular docking and antioxidant screening.

BACKGROUND: Due to its unclear pathophysiology, the pharmacological treatment of fibromyalgia is a challenge for researchers. Studies using medicinal plants, such as those from the genus Lippia, complexed with cyclodextrins (CDs) have shown innovative results. OBJECTIVE: The present research intended to evaluate the effect of an inclusion complex containing ß-cyclodextrin (ßCD) inclusion complex with Lippia grata (LG) essential oil in a chronic musculoskeletal pain model, its central activity and its possible interaction with neurotransmitters involved in pain. METHODS: After acid saline-induced chronic muscle pain, male mice were evaluated for primary and secondary hyperalgesia and muscle strength. Moreover, an antagonist assay was performed to assess the possible involvement of the opioidergic, serotonergic and noradrenergic pathways. In addition, Fos protein in the spinal cord was assessed, and a docking study and antioxidant assays were performed. RESULTS: The treatment with LG-ßCD, especially in the dose of 24mg/kg, was able to significantly decrease (p<0.05) the paw withdrawal and muscle threshold. Furthermore, LG-ßCD was shown to affect the opioidergic and serotonergic pathways. There were no significant changes in muscle strength. Fos protein immunofluorescence showed a significant decrease in expression in the dorsal horn of the spinal cord. The main compounds of LG showed through the docking study interaction energies with the alpha-adrenergic and µOpioid receptors. In all antioxidant assays, LG exhibited stronger antioxidant activities than LG-ßCD. CONCLUSION: This study suggested that LG-ßCD could be considered as a valuable source for designing new drugs in the treatment of chronic pain, especially musculoskeletal pain.

Musculoskeletal Pain and Occupational Variables in Teachers With Voice Disorders and in Those With Healthy Voices-A Pilot Study.

PURPOSE: This study aimed to compare musculoskeletal pain perception in teachers with voice disorders and in those with healthy voices, and to investigate the relationship between musculoskeletal pain and occupational variables (ie, work journey per week and working period). METHOD: Forty-three classroom teachers were divided into two groups: dysphonic group (DG), 32 classroom teachers with voice complaints and voice disorders; and non-DG, 11 classroom teachers without voice complaints and who are vocally healthy. The musculoskeletal pain investigation survey was used to investigate the frequency and intensity of the pain. Occupational variables, such as work journey per week and working period, were investigated by the Voice Production Condition-Teacher questionnaire. The statistical tests used were the Spearman correlation (P ≤ 0.05) and the Mann-Whitney U test (P ≤ 0.05). RESULTS: There was no difference between the frequency and the intensity of musculoskeletal pain regarding dysphonia. Work journey per week was positively related to the frequency and the intensity of laryngeal pain in the DG. The working period had a negative relationship to the frequency and the intensity of musculoskeletal pain in the submandibular region in the DG. CONCLUSION: Classroom teachers with voice disorders and those with healthy voices do not have differences regarding the frequency and the intensity of musculoskeletal pain. Besides dysphonia the pain is an important symptom to be considered in classroom teachers. The occupational variables contributed to the presence of musculoskeletal pain in the region near the larynx, which appears to be directly proportional to work journey per week and inversely proportional to the working period.

Hypermobility and Musculoskeletal Pain in Adolescents.

OBJECTIVE: To determine the prevalence of generalized joint hypermobility (GJH) in a large cohort of Australian children and determine the associations between GJH and musculoskeletal pain. STUDY DESIGN: This is a cross-sectional analysis of the Western Australian Pregnancy Cohort (Raine) Study. Hypermobility was measured in 1584 participants at 14 years of age using the Beighton scoring system, along with a range of other factors including musculoskeletal pain status. Logistic regression models were used to assess independent associations of GJH with factors of interest. RESULTS: The prevalence of GJH was 60.6% and 36.7% in girls and boys, respectively, when defined as a Beighton score of ≥4; when defined as ≥6, it was 26.1% and 11.5%. In girls, positive associations between GJH and higher socioeconomic status and better motor competence were observed. In boys, positive associations between GJH and lower body mass index were observed. After adjusting for potential confounders, an association between number of pain areas in the last month and made worse with sport were identified in boys but not girls. CONCLUSION: The high prevalence rates of GJH as defined by commonly used Beighton cutoff values in this cohort highlight the need to question the appropriateness of these cutoffs in future studies. Future prospective studies of the association between GJH and musculoskeletal pain should be adjusted for confounding variables identified in this study, and be powered for sex-specific analyses owing to the differing prevalence rates and hypermobility correlates in male and female samples.

Muscleskeletal pain in dysphonic women.

OBJECTIVE: To investigate the location, frequency and intensity of muscle pain in dysphonic functional/organofunctional women in comparison to women with healthy voices. METHODS: Sixty women, ranging in age from 18 to 45 years, divided into two groups: Dysphonic Group (DG) - 30 women with functional or organofunctional dysphonia; Non-Dysphonic Group (NDG) - 30 women without vocal complaints, and with adapted voices. All answered a protocol, marking the localization, frequency and intensity symptoms of pain on the temporal area, masseters, submandibular areas, larynx/pharynx, front and back of the neck, shoulders, upper back, lower back, elbows, fists/hands/fingers, hip/this, knees and ankles/feet. The volunteer should report the frequency in which pain was present in the last 12 months: no, rarely, frequently or always. The intensity of pain was measured by visual-analogue scales. The DG and NDG groups were compared using the Mann-Whitney test (p<0.05). RESULTS: The women of the DG reported significantly greater frequency of submandibular area (p=0.008), laryngeal pain (p<0.001), front of the neck (p=0.015), back of the neck (p=0.001), shoulder pain (p=0.027), upper back (p=0.027) and also reported significant greater intensity of pain in the larynx/pharynx (p=0.022) and back of the neck (p=0.003). CONCLUSION: The frequency and intensity of musculoskeletal pain was more frequent and more intense in dysphonic women than in women without vocal complaints, showing that pain may be related to functional and organofunctional dysphonia in women.

Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus.

The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.

Association between hypertension and musculoskeletal complaints: a population-based study.

OBJECTIVE: To investigate the association between hypertension and musculoskeletal complaints among men and women selected by a population-based sample. METHODS: A cross-sectional study, with participants selected using a multistage sampling procedure and interviewed at home, was conducted to investigate the association between hypertension and musculoskeletal complaints. Hypertension was defined by the average of four measurements of blood pressure (BP) at least 140/90  mmHg or use of BP-lowering drugs. Musculoskeletal complaints in the 3 months before the interview were investigated by a structured questionnaire. RESULTS: Among 1858 participants, 58% were women, 64% were 18-49 years old, and 45% had up to 8 years of education. The prevalence of musculoskeletal complaint was 33% [95% confidence interval (CI) 30-36] and of hypertension was 34% (95% CI 32-37). Men and women with hypertension had higher prevalence of musculoskeletal complaint, which was no longer significant in women after adjustment for age, educational level, skin color, BMI, physical inactivity, diabetes mellitus, alcohol consumption, smoking and history of cardiovascular disease. Hypertensive men with uncontrolled hypertension using BP agents had higher prevalence of musculoskeletal complaint (adjusted risk ratio = 1.78; 95% CI 1.11-2.86). CONCLUSIONS: Chronic musculoskeletal complaints are more frequent in men with uncontrolled hypertension under drug treatment. The absence of association in women and in hypertensive men not taking BP drugs suggest that hypertension is not a risk or protection against musculoskeletal complaints.

Need for recovery assessment among nursing professionals and call center operators.

The present study descriptively compares the need for recovery (NFR) among 128 nursing professionals (nurses) and 223 call center operators according cutoff points in the literature (45 and 50) and by means of statistical tests, and verifies the association between NFR scores and the presence of musculoskeletal symptoms. NFR was evaluated with the Need for Recovery Scale and musculoskeletal symptoms were evaluated with the Nordic Musculoskeletal Questionnaire. At a 45 point cutoff, 22% of the call-center workers and 33% of the nurses were classified as fatigued; at a 50 point cutoff, 13% of the call center operators and 27% of the nurses were classified as fatigued. The nurses had higher fatigue levels than the call center workers (p=0.015). Significant correlations were found between NFR scores and musculoskeletal symptoms reported during the previous 12 months (r=0.299, p<0.001) and 7 days (r=0.314, p<0.001). Regarding cutoff points and statistical tests, the NFR scale identified higher fatigue levels among the nurses and was demonstrated to be a useful tool for evaluating worker well-being.

Intervencionismo musculoesquelético en cuidados paliativos / Musculoskeletal interventionism on palliatives cares

El presente estudio descriptivo da cuenta de resultados en aplicación de intervencionismo para alivio del dolor musculoesquelético en enfermos con diagnóstico de cáncer terminal, pero que se mantienen activos, e ingresados a Unidad de Alivio del Dolor y Cuidados Paliativos del Hospital del Salvador en Santiago de Chile, entre los meses de julio del 2010 a marzo del 2011. Los principales diagnósticos causantes de dolor musculoesquelético fueron síndrome miofascial, artrosis y ambos diagnósticos combinados. Las técnicas usadas fueron infiltración de punto gatillo, infiltración intra-articular, o ambas. Los resultados mostraron disminución estadísticamente significativa en la intensidad del dolor en forma global en escala numérica, así como al analizar según tipo de intervención por separado. La media de duración del efecto fue de un mes en el caso de infiltración de puntos gatillo. Este tiempo podría constituir una ventana analgésica en pacientes con sobrevida limitada y controlaría el alza de analgésicos. Cuando el DME está presente, el uso de terapia intervencionista para DME podría ser una herramienta útil en Cuidados Paliativos, pero se requieren mayores estudios con mejor diseño estadístico para poder obtener conclusiones con mayor nivel de seguridad.

This descriptive study gives an account of results of interventionism implementation to the relief of musculoskeletal pain in patients that were diagnosed with terminal cancer; but have retained activity level, which are given they state of health at the Unit Pain Relief And Palliative Care at Hospital del Salvador in Santiago, Chile between the months of July 2010 to March 2011. The main causes of musculoskeletal pain diagnoses were Myofascial pain syndrome, arthritis and both combined conditions. The techniques used were trigger point infiltration, intra-articular joint infiltration or both together. The results showed statistical significant decrease in pain intensity on a numerical scale global, as well as the analysis by the type of separately intervention. The mean duration of effect was about a month in the case of infiltration of trigger points, this time window could be a survival analgesic in patients with limited and control the rise of analgesics. When the DME is present, the use of interventional therapy for DMA could be useful tool in palliative care, but require larger studies with better statistical design in order to draw conclusions with greater security.