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New Advances in the Treatment of Chronic Musculoskeletal Pain
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New Advances in the Treatment of Chronic Musculoskeletal Pain

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Chronic Care".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 21352

Special Issue Editor

Dr. Eleni Kapreli

E-Mail Website
Guest Editor
Department of Physiotherapy, University of Thessaly, 3rd Km Old National Road Lamia–Athens, 35100 Lamia, Greece
Interests: sports injuries rehabilitation; neuroplasticity; neuromuscular control; chronic pain; central sensitization; clinical communication skills; lifestyle medicine

Special Issue Information

Dear Colleagues,

It is evident that chronic musculoskeletal pain (CMSKP) can be an extremely challenging condition for both patients and healthcare providers. Increasingly, it is being recognized as a public health issue, with severe clinical, economic, and social consequences. Approximately one third of the adult population suffers from CMSKP, which causes long-term complications that require further healthcare, resulting in a substantial decrease in patients' quality of life. Current evidence reveals two main positive methods in CMSKP treatment: one is the multifaceted approach based on the biopsychosocial model and the specific needs of the patient and the other one is individualized management according to pain phenotyping.

CMSKP is well known to be influenced by a number of factors that interact and contribute to its severity and persistence, including physical inactivity, sedentary behavior, poor sleep, unhealthy diet, stress, and smoking. Moreover, psychosocial and cognitive behavioral factors, including pain catastrophizing, anxiety, fear-avoidance, incorrect illness perceptions and depression, are not only associated with the transition from acute to chronic pain but they are also implicated in the severity and extent of pain and disability as well. It is therefore necessary for CMSKP treatment to include a multidisciplinary approach that integrates physiological, cognitive, psychological, clinical, and self-regulation techniques.

In precision medicine, patients are classified into subgroups based on their susceptibility to certain diseases, their biological profiles, their estimated prognosis levels or their response to a specific treatment, enabling them to receive personalized care based on their unique characteristics. When it comes to CMSKP treatment, it seems a promising and clinically relevant issue to be able to categorize patients into the three major pain phenotypes (i.e., nociceptive, neuropathic, and nociplastic as defined by the International Association for the Study of Pain (IASP)) as it can help patients access pain management based on their pain mechanism.

This Special Issue welcomes studies or reviews (systematic, scoping reviews) considering new advances in the rehabilitation of chronic musculoskeletal pain, on the topics including but not limited to:

  • CMSKP phenotyping treatment
  • Clinical communication skills in CMSKP management
  • Cognitive behavioral therapy
  • Pain neuroscience education
  • New technology such as mHealth and virtual reality
  • Rehabilitation techniques such as exercise therapy, behavioral graded activity, manual therapy, acupuncture, yoga and tai chi
  • Self-regulation/mindfulness strategies
  • Electrophysical agents such as transcutaneous electrical nerve stimulation
  • Therapeutic modalities such as transcranial magnetic stimulation
  • Lifestyle approaches such as stress management, sleep management, nutrition
  • Others.

Dr. Eleni Kapreli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nociplastic pain
  • nociceptive pain
  • neuropathic pain
  • precision medicine
  • pain neuroscience education
  • epigenetics
  • lifestyle medicine
  • exercise
  • therapeutic modalities
  • electrophysical agents
  • rehabilitation techniques

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Published Papers (6 papers)

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Research

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10 pages, 251 KiB  
Article
Association between Chronic Pain and Sarcopenia in Greek Community-Dwelling Older Adults: A Cross-Sectional Study
by Maria Tsekoura, Evdokia Billis, Charalampos Matzaroglou, Elias Tsepis and John Gliatis
Healthcare 2024, 12(13), 1303; https://doi.org/10.3390/healthcare12131303 - 29 Jun 2024
Viewed by 1125
Abstract
(1) Background: Sarcopenia and chronic pain are prevalent syndromes among older adults that negatively affect their quality of life. The present study aimed to investigate the relationship between chronic pain and sarcopenia among Greek community-dwelling older adults. (2) Methods: Older adults >60 years [...] Read more.
(1) Background: Sarcopenia and chronic pain are prevalent syndromes among older adults that negatively affect their quality of life. The present study aimed to investigate the relationship between chronic pain and sarcopenia among Greek community-dwelling older adults. (2) Methods: Older adults >60 years of age were enrolled in this descriptive, cross-sectional study. Sarcopenia status was assessed according to the EWGSOP2 2019 algorithm. This assessment included the evaluation of muscle strength, body composition and gait speed. Pain location and pain characteristics were assessed using a self-reported questionnaire. Pain severity was assessed via the visual analog scale. The participants were also asked to fill out the SARC-F, the Hospital Anxiety and Depression Scale (HADS) and the Falls Efficacy Scale-International (FES-I) questionnaire. (3) Results: This study included 314 participants with a mean age of 71.3 ± 7.4 years. The prevalence of sarcopenia was 19.4 (n = 61), and 44.26% of the sarcopenic participants recorded chronic pain. Chronic pain was associated with sarcopenia, comorbidities, the number of drugs and HADS. (4) Conclusions: The results demonstrated a high percentage of chronic pain in the sarcopenic population. The results also highlight the importance of the detection of chronic pain in older patients with sarcopenia in order to develop effective preventive and therapeutic strategies. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
14 pages, 495 KiB  
Article
Do Patients with Chronic Spinal Pain and Comorbid Insomnia Have More Features of Central Sensitization? A Case-Control Study
by Lucas Araújo Almeida, Thomas Bilterys, Eveline Van Looveren, Olivier Mairesse, Barbara Cagnie, Mira Meeus, Maarten Moens, Dorien Goubert, Wouter Munneke, Lieven Danneels, Kelly Ickmans, Paula Rezende Camargo, Jo Nijs, Anneleen Malfliet and Liesbet De Baets
Healthcare 2023, 11(24), 3152; https://doi.org/10.3390/healthcare11243152 - 12 Dec 2023
Viewed by 1592
Abstract
Background: Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical [...] Read more.
Background: Chronic spinal pain (CSP) is a major public health problem worldwide, frequently related to sleep problems. Central sensitization (CS) may worsen the clinical picture of CSP patients with insomnia. The aim of this study was to compare self-reported and objectively measured clinical outcomes between insomniac CSP patients with comorbid insomnia with and without symptoms of CS. Methods: A case-control study on baseline self-reported sleep, functioning, and psychological distress through online questionnaires. Objective sleep and physical activity parameters and pressure pain thresholds (PPTs) were assessed through polysomnography, actigraphy, and digital algometry, respectively. Independent sample t-test and Mann–Whitney U tests were used to examine possible differences in the outcome measures between the groups. Results: Data from 123 participants were included and revealed no statistically significant group for objective sleep and physical activity parameters. The CS group, however, presented with worse self-reported sleep (quality sleep, insomnia severity, and dysfunctional beliefs about sleep), increased mental and physical fatigue, and higher psychological distress (anxiety and depressive symptoms), and reported lower PPTs. Conclusions: symptoms of CS may influence perceived sleep and affect functional health and well-being perception but do not seem to affect objective sleep and physical activity. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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Review

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14 pages, 644 KiB  
Review
What Do We Know about Nociplastic Pain?
by Kacper Bułdyś, Tomasz Górnicki, Dariusz Kałka, Ewa Szuster, Małgorzata Biernikiewicz, Leszek Markuszewski and Małgorzata Sobieszczańska
Healthcare 2023, 11(12), 1794; https://doi.org/10.3390/healthcare11121794 - 17 Jun 2023
Cited by 20 | Viewed by 6555
Abstract
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of [...] Read more.
Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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Other

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8 pages, 247 KiB  
Case Report
Hard Flaccid Syndrome: A Biopsychosocial Management Approach with Emphasis on Pain Management, Exercise Therapy and Education
by Evdokia Billis, Stavros Kontogiannis, Spyridon Tsounakos, Eleni Konstantinidou and Konstantinos Giannitsas
Healthcare 2023, 11(20), 2793; https://doi.org/10.3390/healthcare11202793 - 22 Oct 2023
Cited by 1 | Viewed by 2642
Abstract
Hard flaccid syndrome (HFS) is a rather rare, acquired clinical entity affecting young men’s well-being, sexual and social life. HFS presents with a cluster of symptoms including penile-specific somatosensory disturbances, a semi-rigid penis at the flaccid state without any stimulation or desire, erectile [...] Read more.
Hard flaccid syndrome (HFS) is a rather rare, acquired clinical entity affecting young men’s well-being, sexual and social life. HFS presents with a cluster of symptoms including penile-specific somatosensory disturbances, a semi-rigid penis at the flaccid state without any stimulation or desire, erectile dysfunction, perineal and/or penile pain, associated urinary symptoms, emotional distress as well as other psychosocial and stress-related manifestations. Although its pathophysiology is still not well understood, initial penile trauma causing minor nerve and vascular disturbances to the penis and associated pelvic floor musculature is suggested to trigger the syndrome. Despite the scarcity of research on HFS, the present report describes a case of a young male clinically diagnosed with HFS, who benefited from a biopsychosocial management strategy, focusing on pain management, therapeutic exercise approaches, such as pelvic floor exercise re-education, graded exposure to activity as well as education on lifestyle and stress-related modifications. This holistic management approach has been clinically reasoned in this case report, and the need for more evidence-based studies developing diagnosing criteria, elaborating pathophysiological mechanisms and testing the efficiency of different therapeutic options is highlighted. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
15 pages, 1478 KiB  
Systematic Review
Virtual Reality-Based Exercise Therapy for Patients with Chronic Musculoskeletal Pain: A Scoping Review
by Paraskevi Bilika, Natalia Karampatsou, Giorgos Stavrakakis, Achilleas Paliouras, Yannis Theodorakis, Nikolaos Strimpakos and Eleni Kapreli
Healthcare 2023, 11(17), 2412; https://doi.org/10.3390/healthcare11172412 - 28 Aug 2023
Cited by 5 | Viewed by 4083
Abstract
This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the [...] Read more.
This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the studies to assess eligibility, with a third author resolving any discrepancies. Data were extracted and summarized in a narrative format by three independent raters. Clinical trials were evaluated using the PEDro scale to assess the effectiveness of virtual-reality-based exercise therapy in chronic musculoskeletal pain patients. A total of 162 articles were identified from the databases. After applying the inclusion criteria, nine articles were considered suitable for analysis, including six randomized clinical trials. The selected articles were categorized based on study characteristics, virtual-reality-based exercise therapy interventions (including technologies and equipment used), exercise interventions, outcome measures, and effectiveness. The findings indicate that virtual-reality-based exercise therapy shows promising results in reducing pain, improving disability, enhancing range of motion, and increasing treatment satisfaction in patients with chronic musculoskeletal pain. However, it is not possible to conclude that virtual-reality-based exercise therapy is superior to other treatments due to the limited number of available studies, heterogeneity in application protocols, and varying methodological quality. Further research is needed to draw more definitive conclusions. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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14 pages, 569 KiB  
Systematic Review
Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review
by Aikaterini Pantelis Sivrika, Eleni Papadamou, George Kypraios, Demetris Lamnisos, George Georgoudis and Dimitrios Stasinopoulos
Healthcare 2023, 11(16), 2268; https://doi.org/10.3390/healthcare11162268 - 11 Aug 2023
Cited by 3 | Viewed by 4156
Abstract
Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life [...] Read more.
Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18–65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson’s protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric–concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT. Full article
(This article belongs to the Special Issue New Advances in the Treatment of Chronic Musculoskeletal Pain)
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