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Recent Advances in Musculoskeletal Pain and Its Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (27 May 2022) | Viewed by 55350

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Prof. Dr. Daniel Pecos-Martín

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Physiotherapy and Pain Research Group, University of Alcalá, Department of Physical Therapy, 28805 Alcalá de Henares, Spain
Interests: musculoskeletal pain; shoulder musculoskeletal disorders; oncology pain management; manual therapy, dry needling; therapeutic exercises; pain neuroscience education
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Prof. Dr. Deborah Falla

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Guest Editor

Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham B15 2TT, UK
Interests: spinal pain, low back pain, neck pain, exercise, motor control, musculoskeletal pain, electrophysiology, kinesiology

Special Issue Information

Dear Colleagues,

Musculoskeletal disorders continue to be one of the leading causes of years lived with disability. The evidence-based management of people with musculoskeletal disorders has developed significantly thanks to the contribution of basic and applied sciences combined with clinical reasoning to support the action of the clinician for the evaluation and management of complex disorders of the musculoskeletal system. Nevertheless, the effective management of people with musculoskeletal disorders remains challenging.

This Special Issue in the Journal of Clinical Medicine aims to highlight recent advances which have improved the understanding of different assessments and/or innovative and personalised treatments for the management of musculoskeletal pain. Authors are encouraged to submit their original research including systematic reviews and meta-analyses, consensus statements, clinical trials, study protocol, observational studies, and experimental work which present recent advances in musculoskeletal pain and its management.

Prof. Dr. Daniel Pecos-Martín
Prof. Dr. Deborah Falla
Guest Editors

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Keywords

musculoskeletal pain
chronic pain
personalised rehabilitation
exercise
multidisciplinary management

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Published Papers (11 papers)

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Research

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8 pages, 264 KiB

Open AccessArticle

Real versus Sham Manual Therapy in Addition to Therapeutic Exercise in the Treatment of Non-Specific Shoulder Pain: A Randomized Controlled Trial

by Fermin Naranjo-Cinto, Adriana-Imelda Cerón-Cordero, Claudia Figueroa-Padilla, Dulce Galindo-Paz, Samuel Fernández-Carnero, Tomás Gallego-Izquierdo, Susana Nuñez-Nagy and Daniel Pecos-Martín

J. Clin. Med. 2022, 11(15), 4395; https://doi.org/10.3390/jcm11154395 - 28 Jul 2022

Cited by 4 | Viewed by 5389

Abstract

The aim of this study was to evaluate if manual therapy added to a therapeutic exercise program produced greater improvements than a sham manual therapy added to same exercise program in patients with non-specific shoulder pain. This was an evaluator-blinded randomized controlled trial. Forty-five subjects were randomly allocated into one of three groups: manual therapy (glenohumeral mobilization technique and rib-cage technique); thoracic sham manual therapy (glenohumeral mobilization technique and rib-cage sham technique); or sham manual therapy (sham glenohumeral mobilization technique and rib-cage sham technique). All groups also received a therapeutic exercise program. Pain intensity, disability and pain-free active shoulder range of motion were measured post treatment and at 4-week and 12-week follow-ups. Mixed-model analyses of variance and post hoc pairwise comparisons with Bonferroni corrections were constructed for the analysis of the outcome measures. All groups reported improved pain intensity, disability and pain-free active shoulder range of motion. However, there were no between-group differences in these outcome measures. The addition of the manual therapy techniques applied in the present study to a therapeutic exercise protocol did not seem to add benefits to the management of subjects with non-specific shoulder pain. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

12 pages, 1427 KiB

Open AccessArticle

A Comparison of EQ-5D-3L, EQ-5D-5L, and SF-6D Utilities of Patients with Musculoskeletal Disorders of Different Severity: A Health-Related Quality of Life Approach

by Nikolaos Kontodimopoulos, Eleni Stamatopoulou, Sousana Gazi, Dimitra Moschou, Michail Krikelis and Michael A. Talias

J. Clin. Med. 2022, 11(14), 4097; https://doi.org/10.3390/jcm11144097 - 15 Jul 2022

Cited by 4 | Viewed by 2375

Abstract

This study compares EQ-5D-3L, EQ-5D-5L, and SF-6D utilities in patients with different musculoskeletal (MSK) disorders, also differing in disease severity as defined by valid clinical indexes. Utilities were measured from a cross-sectional sample of rheumatoid arthritis (N = 114), psoriatic arthritis (N = 57), ankylosing spondylitis (N = 49), and osteopenia/osteoporosis (N = 95) patients. For the first three groups, disease activity (severity) was measured with the DAS-28, DAPSA, and BASDAI clinical indexes, respectively. Mean differences and effect sizes were measured, and agreement between utilities was estimated with the intraclass correlation coefficient and Bland–Altman plots. Higher agreement was observed between EQ-5D-5L and SF-6D, compared to EQ-5D-3L and SF-6D, in all MSK disorder groups and severity levels. In groups with moderate to high severity, agreement between EQ-5D-3L/SF-6D and EQ-5D-5L/SF-6D was between low and fair, and both EQ-5D-3L and 5L utilities were lower than SF-6D (p < 0.001). On the other hand, in remission or low activity groups, agreement was excellent, and SF-6D utilities were again typically higher than EQ-5D-3L/5L, but not significantly. In more severe patients, SF-6D generated significantly higher utilities than EQ-5D-3L and 5L, which is consistent with most previous studies. Such discrepancies could have implications on economic evaluations of interventions targeting patients with MSK disorders. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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24 pages, 1071 KiB

Open AccessArticle

Assessment of Neuromuscular and Psychological Function in People with Recurrent Neck Pain during a Period of Remission: Cross-Sectional and Longitudinal Analyses

by Ahmed Alalawi, Valter Devecchi, Alessio Gallina, Alejandro Luque-Suarez and Deborah Falla

J. Clin. Med. 2022, 11(7), 2042; https://doi.org/10.3390/jcm11072042 - 6 Apr 2022

Cited by 4 | Viewed by 3047

Abstract

The aim of this study was to examine for the presence of differences in neuromuscular and psychological function in individuals with recurrent neck pain (RNP) or chronic neck pain (CNP) following a whiplash trauma compared to healthy controls. A secondary aim was to examine whether neuromuscular characteristics together with psychological features in people with RNP were predictive of future painful episodes. Multiple features were assessed including neck disability, kinesiophobia, quality of life, cervical kinematics, proprioception, activity of superficial neck flexor muscles, maximum neck flexion and extension strength, and perceived exertion during submaximal contractions. Overall, those with RNP (n = 22) and CNP (n = 8) presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to controls (n = 15). Prediction analysis in the RNP group revealed that a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictors of higher neck disability at a 6-month follow-up. This preliminary study shows that participants with RNP presented with some degree of altered neuromuscular features and poorer psychological function with respect to healthy controls and these features were similar to those with CNP. Neck flexor weakness was predictive of future neck disability. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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16 pages, 954 KiB

Open AccessArticle

Profiling and Association over Time between Disability and Pain Features in Patients with Chronic Nonspecific Neck Pain: A Longitudinal Study

by Gorka Ortego, Enrique Lluch, Pablo Herrero, Shellie Ann Boudreau and Victor Doménech-García

J. Clin. Med. 2022, 11(5), 1346; https://doi.org/10.3390/jcm11051346 - 28 Feb 2022

Cited by 12 | Viewed by 2841

Abstract

Objectives: To longitudinally investigate the relationships between neck/arm disability and pain profile measures in individuals with chronic nonspecific neck pain (NSNP) at baseline, one month, and six months after a standardized physiotherapy intervention. A secondary aim was to compare pain sensitivity of individuals with chronic NSNP at baseline to healthy controls. Methods: A total of sixty-eight individuals with chronic NSNP and healthy controls were recruited. Neck disability index (NDI), the 11-item disabilities of the arm, shoulder, and hand questionnaire (QuickDASH), temporal summation (TS), pressure pain thresholds (PPTs), pain intensity and pain extent were assessed in individuals with chronic NSNP. For the cross-sectional assessment, TS and PPTs were compared to healthy controls. Results: After following a standardized physiotherapy intervention, local and distal PPTs to the neck region decreased at one and six month follow-ups, respectively. Pain extent decreased at one and six months. Furthermore, a positive correlation between neck/arm disability and pain intensity was found at baseline, whereas moderate positive correlations (e.g., between NDI and pain extent) at baseline, one and six month follow-ups and negative correlations at six months (e.g., between arm disability and PPTs) were found. Discussion: Overall, these findings indicate that pain sensitivity can worsen following treatment despite reduced pain extent and unchanged neck disability and pain intensity scores over a six-month period in individuals with chronic NSNP. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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11 pages, 283 KiB

Open AccessArticle

Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?

by Ahmed Alalawi, David W. Evans, Bernard Liew, Anneli Peolsson, Nicola Heneghan, Alison Rushton, Gunnel Peterson, Marco Barbero and Deborah Falla

J. Clin. Med. 2022, 11(3), 555; https://doi.org/10.3390/jcm11030555 - 22 Jan 2022

Cited by 5 | Viewed by 4104

Abstract

This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159–0.909) and 2-year (p = 0.029, 0.057–0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: −0.28–0.499) and 2 years (p = 0.401, −0.226–0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

10 pages, 240 KiB

Open AccessArticle

Opioid Prescription Following Wrist and Ankle Fracture Fixation in Scotland—Tradition Prevails

by William T. Gardner, David R. W. MacDonald, Matthew J. Kennedy, Alastair C. Faulkner, Joshua R. McIntyre, Patrice Forget, Stuart A. Aitken, Iain M. Stevenson and on behalf of the SCORE Collaborative

J. Clin. Med. 2022, 11(2), 468; https://doi.org/10.3390/jcm11020468 - 17 Jan 2022

Cited by 2 | Viewed by 2142

Abstract

The American ‘opioid crisis’ is rapidly spreading internationally. Perioperative opioid use increases the risk of long-term opioid use. We review opioid use following wrist and ankle fracture fixation across Scotland, establishing prescribing patterns and associations with patient, injury, or perioperative factors. Six Scottish orthopedic units contributed. A total of 598 patients were included. Patient demographics were similar across all sites. There was variation in anesthetic practice, length of stay, and AO fracture type (p < 0.01). For wrist fractures, 85.6% of patients received a discharge opioid prescription; 5.0% contained a strong opioid. There was no significant variation across the six units in prescribing practice. For ankle fractures, 82.7% of patients received a discharge opioid prescription; 17% contained a strong opioid. Dundee and Edinburgh used more strong opioids; Inverness and Paisley gave the least opioids overall (p < 0.01). Younger patient age, location, and length of stay were independent predictors of increased prescription on binary regression. Despite variability in perioperative practices, discharge opioid analgesic prescription remains overwhelmingly consistent. We believe that the biggest influence lies with the prescriber-institutional ‘standard practice’. Education of these prescribing clinicians regarding the risk profile of opioids is key to reducing their use following surgery, thus lowering long-term opioid dependence. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

13 pages, 904 KiB

Open AccessArticle

The Spatial Extent of Pain Is Associated with Pain Intensity, Catastrophizing and Some Measures of Central Sensitization in People with Frozen Shoulder

by Mercè Balasch-Bernat, Lirios Dueñas, Marta Aguilar-Rodríguez, Deborah Falla, Alessandro Schneebeli, Marta Navarro-Bosch, Enrique Lluch and Marco Barbero

J. Clin. Med. 2022, 11(1), 154; https://doi.org/10.3390/jcm11010154 - 28 Dec 2021

Cited by 12 | Viewed by 8670

Abstract

The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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18 pages, 950 KiB

Open AccessArticle

Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S)

by María del Rocío Ibancos-Losada, María Catalina Osuna-Pérez, Irene Cortés-Pérez, Desirée Montoro-Cárdenas and Ángeles Díaz-Fernández

J. Clin. Med. 2022, 11(1), 151; https://doi.org/10.3390/jcm11010151 - 28 Dec 2021

Cited by 4 | Viewed by 2307

Abstract

Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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14 pages, 1012 KiB

Open AccessArticle

The Main Role of Diaphragm Muscle as a Mechanism of Hypopressive Abdominal Gymnastics to Improve Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial

by Davinia Vicente-Campos, Sandra Sanchez-Jorge, Pablo Terrón-Manrique, Marion Guisard, Marion Collin, Borja Castaño, David Rodríguez-Sanz, Ricardo Becerro-de-Bengoa-Vallejo, José López Chicharro and César Calvo-Lobo

J. Clin. Med. 2021, 10(21), 4983; https://doi.org/10.3390/jcm10214983 - 27 Oct 2021

Cited by 21 | Viewed by 5406

Abstract

Background: Chronic low back pain (LBP) has been stated as one of the main health concerns in the XXI century due to its high incidence. Objective: The objective of this study was to determine the effects of an 8-week program of hypopressive abdominal gymnastics (HAG) on inspiratory muscle strength, diaphragm thickness, disability and pain in patients suffering from non-specific chronic LBP. Methods: A total of 40 patients with chronic LBP were randomly divided into two groups. The experimental group carried out an 8-week supervised program of HAG (two sessions/week), whereas the control group did not receive any treatment. Outcomes were measured before and after the intervention, comprising diaphragm thickness during relaxed respiratory activity, maximal inspiratory pressure (PI_max), pain intensity (NRS), pressure pain threshold and responses to four questionnaires: Physical Activity Questionnaire (PAQ), Roland–Morris Disability Questionnaire (RMQ), Central Sensitization Inventory (CSI) and Tampa Scale of Kinesiophobia-11 Items (TSK-11). Results: Statistically significant differences (p < 0.05) were observed for greater thickness of the left and right hemi-diaphragms at inspiration, as well as higher PI_max and decreased NRS, CSI and RMQ scores in the intervention group. After treatment, the increases in the thickness of the left and right hemi-diaphragms at inspiration and PI_max, as well as the decrease in the NRS and RMQ scores, were only predicted by the proposed intervention (R² = 0.118–0.552). Conclusions: An 8-week HAG intervention seemed to show beneficial effects and predicted an increase in diaphragm thickness and strength during inspiration, as well as a reduction in pain intensity, central sensitization and disability, in patients suffering from chronic non-specific LBP with respect to non-intervention. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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Review

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27 pages, 2695 KiB

Open AccessReview

Chronic Pain in Musculoskeletal Diseases: Do You Know Your Enemy?

by Roberto Bonanni, Ida Cariati, Virginia Tancredi, Riccardo Iundusi, Elena Gasbarra and Umberto Tarantino

J. Clin. Med. 2022, 11(9), 2609; https://doi.org/10.3390/jcm11092609 - 6 May 2022

Cited by 37 | Viewed by 12015

Abstract

Musculoskeletal pain is a condition that characterises several diseases and represents a constantly growing issue with enormous socio-economic burdens, highlighting the importance of developing treatment algorithms appropriate to the patient’s needs and effective management strategies. Indeed, the algic condition must be assessed and treated independently of the underlying pathological process since it has an extremely negative impact on the emotional and psychic aspects of the individual, leading to isolation and depression. A full understanding of the pathophysiological mechanisms involved in nociceptive stimulation and central sensitization is an important step in improving approaches to musculoskeletal pain. In this context, the bidirectional relationship between immune cells and neurons involved in nociception could represent a key point in the understanding of these mechanisms. Therefore, we provide an updated overview of the magnitude of the musculoskeletal pain problem, in terms of prevalence and costs, and summarise the role of the most important molecular players involved in the development and maintenance of pain. Finally, based on the pathophysiological mechanisms, we propose a model, called the “musculoskeletal pain cycle”, which could be a useful tool to counteract resignation to the algic condition and provide a starting point for developing a treatment algorithm for the patient with musculoskeletal pain. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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22 pages, 835 KiB

Open AccessReview

The Role of Rehabilitative Ultrasound Imaging Technique in the Lumbopelvic Region as a Diagnosis and Treatment Tool in Physiotherapy: Systematic Review, Meta-Analysis and Meta-Regression

by Samuel Fernández-Carnero, Carlos Martin-Saborido, Alexander Achalandabaso Ochoa-Ruiz de Mendoza, Alejandro Ferragut-Garcias, Juan Nicolás Cuenca-Zaldivar, Alejandro Leal-Quiñones, Cesar Calvo-Lobo and Tomas Gallego-Izquierdo

J. Clin. Med. 2021, 10(23), 5699; https://doi.org/10.3390/jcm10235699 - 3 Dec 2021

Cited by 9 | Viewed by 4393

Abstract

Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I² heterogeneity indexes for multifidus muscle thickness (I² = 95%), low back pain (I² = 92%) and abdominal pain (I² = 95%), not important for transversus abdominis muscle thickness (I² = 22%), significant heterogenity (I² = 69%) depending on the subgroup and not important internal oblique muscle thickness (I² = 0%) and external oblique muscle thickness (I² = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area. Full article

(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)

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