scholarly journals Central neurobiological effects of physical exercise in individuals with chronic musculoskeletal pain: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036151
Author(s):  
Rutger M J de Zoete ◽  
Kenneth Chen ◽  
Michele Sterling
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Physical Exercise ◽  
Clinical Outcomes ◽  
Musculoskeletal Pain ◽  
Exercise Intervention ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Brain Areas

ObjectivePrimary objectives: to investigate the central neurobiological effects (using MRI) of physical exercise in individuals with chronic pain. Secondary objectives: (1) to investigate the associations between central changes and clinical outcomes and (2) to investigate whether different types and dosages of physical exercise exert different central changes.DesignSystematic review searching four electronic databases up to September 2018: AMED, CINAHL, Embase and MEDLINE. Two reviewers independently assessed the methodological quality of included studies using the Cochrane Collaboration’s Risk of Bias in Non-Randomised Studies-I tool. A standardised extraction table was used for data extraction, which was performed by two reviewers.InterventionsStudies reporting any physical exercise intervention in any chronic musculoskeletal pain condition were included. Eligibility of 4011 records was screened independently by two reviewers, and four studies were included in the review.Primary and secondary outcome measuresPrimary outcome: any brain outcome assessed with any MR technique. Secondary outcomes: any self-reported clinical outcomes, and type and dosage of the exercise intervention.ResultsAll four studies had high risk of bias. There was heterogeneity between the brain areas studied and the types of exercise interventions delivered. All studies reported functional MRI changes in various brain areas following an exercise intervention. Insufficient data were available to conduct a meta-analysis or to answer the secondary aims.ConclusionsOnly a limited number of studies were available and all were at high risk of bias. None of the studies was randomised or included blinded assessment. Exercise may exert effects on brain neurobiology in people with chronic pain. Due to the high risk of bias, future studies should use a randomised study design. Investigation of morphological brain changes could be included.PROSPERO registration numberCRD42018108179.

scholarly journals Does Conservative Treatment Change the Brain in Patients with Chronic Musculoskeletal Pain? A Systematic Review

2017 ◽  
Vol 3 (20;3) ◽  
pp. 139-154 ◽  
Author(s):  
Mira Meeus
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Musculoskeletal Pain ◽  
Resting State ◽  
Behavioral Therapy ◽  
Brain Activity ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Current Review

Background: Chronic musculoskeletal pain is characterized by maladaptive central neuroplastic changes. Many observational studies have demonstrated that chronic pain states are associated with brain alterations regarding structure and/or function. Rehabilitation of patients with chronic musculoskeletal pain may include cognitive, exercise, or multimodal therapies. Objective: The current review aims to provide a constructive overview of the existing literature reporting neural correlates, based on brain magnetic resonance imaging (MRI) techniques, following conservative treatment in chronic musculoskeletal pain patients. Study Design: Systematic review of the literature. Methods: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature was searched from 3 databases and screened for eligibility. Methodological quality across studies was assessed with Cochrane Collaboration’s tool for assessing risk of bias and quality of evidence was determined applying the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: A total of 9 eligible studies were identified with a predominant high risk of bias. Cognitive behavioral therapy induced several structural and functional changes predominantly in prefrontal cortical regions and a shift from affective to sensory-discriminative brain activity after behavioral extinction training. Multidisciplinary treatment in pediatric complex regional pain syndrome facilitated normalization of functional connectivity of resting-state networks and the amygdala, and increased gray matter in prefrontal and specific subcortical areas. Exercise therapy led to specific for resting-state functional connectivity and a trend towards pressure-induced brain activity changes. Limitations: A very small number of studies was available, which furthermore exhibited small study samples. Moreover, only 2 of the included studies were randomized controlled trials. Conclusions: It is likely that conservative treatments may induce mainly functional and structural brain changes in prefrontal regions in patients with chronic musculoskeletal pain. Due to the relatively high risk of bias across the included studies, future studies with randomized designs are needed to confirm the current findings. In addition, more research evaluating the treatmentinduced effects on white matter and whole-brain network dynamics are warranted. Key words: Chronic pain, musculoskeletal pain, MRI, functional MRI, therapy, rehabilitation, cognitive behavioral therapy, exercise therapy

scholarly journals Evaluation of self-efficacy determinants in community-dwelling older adults with chronic musculoskeletal pain

2020 ◽  
Vol 14 (3) ◽  
pp. 160-165
Author(s):  
Flavia Gonçalves Ziegler ◽  
Marcos Aparecido Sarria Cabrera ◽  
Aline Silva de Almeida ◽  
Thaisa Morais Alexandre ◽  
Amanda da Silva Pereira ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Physical Exercise ◽  
Musculoskeletal Pain ◽  
Self Efficacy ◽  
Community Dwelling ◽  
Chronic Musculoskeletal Pain ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Community Dwelling Older Adults

INTRODUCTION: Self-efficacy is defined as the strength of a person’s convictions in being able to perform a given activity and obtain the expected result. It may act as a potent mediator between chronic musculoskeletal pain and how older adults cope with their disabilities. OBJECTIVE: To evaluate the determinants of self-efficacy beliefs and fear of physical exercise in community-dwelling older adults with chronic musculoskeletal pain. METHODS: This cross-sectional study recruited older adults with chronic musculoskeletal pain. Only individuals living in an urban area in southern Brazil and who reported pain for more than 3 months were included. A convenience sample was selected in a nonprobabilistic fashion. The study variables consisted of sociodemographic data; pain based on the Brief Pain Inventory and the Leeds Assessment of Neuropathic Symptoms and Signs for Patients with Chronic Pain; and self-efficacy based on the Chronic Pain Self-Efficacy Scale. Also, simple questions were created for physical exercise beliefs. For statistical analysis, absolute and relative frequency, χ2 test, and Mann-Whitney U test were used as appropriate. RESULTS: The sample consisted of 193 older adults, mostly women with low level of education. Self-efficacy was best rated by older adults living alone and by those who were classified as exclusively nociceptive pain. CONCLUSION: Despite having chronic pain, older adults with higher self-efficacy feel confident in performing their tasks and have greater ability to cope with changes related to aging and to engage in self-care.

scholarly journals Co-occurrence of Chronic Musculoskeletal Pain and Cardiovascular Diseases: A Systematic Review with Meta-analysis

Pain Medicine ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 1106-1121 ◽  
Author(s):  
Crystian B Oliveira ◽  
Chris G Maher ◽  
Marcia R Franco ◽  
Steven J Kamper ◽  
Christopher M Williams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Musculoskeletal Pain ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Population Based ◽  
Risk Of Bias ◽  
Chronic Musculoskeletal Pain ◽  
Pain Status

Abstract Objective To determine the magnitude of the association between cardiovascular disease and chronic musculoskeletal pain. Design Systematic review with meta-analysis. Methods A comprehensive search was performed in five electronic databases. Population-based studies reporting the prevalence of cardiovascular diseases in adults stratified by chronic musculoskeletal pain status were considered eligible. Two independent reviewers performed the screening of the records following the inclusion criteria, extracted data, and evaluated the risk of bias of the included studies using an assessment tool of risk of bias for observational studies. In addition, we assessed the overall quality of evidence using an adaptation of the GRADE approach for prognosis. Results Twenty studies were included in this review. There was high-quality evidence that people with chronic musculoskeletal pain are 1.91 times more likely to report having a cardiovascular disease compared with those without chronic musculoskeletal pain (risk ratio = 1.91, 95% confidence interval = 1.64–2.21). Conclusions Our findings demonstrated associations between chronic musculoskeletal pain and any cardiovascular diseases. Future studies are still warranted to better understand the association between chronic musculoskeletal pain and the specific types of cardiovascular diseases.

A systematic review of internet-based interventions for women with chronic pain

2020 ◽  
Vol 84 (1) ◽  
pp. 6-14
Author(s):  
María José Ariza-Mateos ◽  
Irene Cabrera-Martos ◽  
Esther Prados-Román ◽  
María Granados-Santiago ◽  
Janet Rodríguez-Torres ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
High Risk ◽  
Methodological Quality ◽  
Risk Of Bias ◽  
Face To Face ◽  
Cognitive Behavioural ◽  
Rigorous Research ◽  
Improve Health

Introduction To evaluate the effects of internet-based interventions on physical and psychosocial outcomes in women with chronic pain through a systematic review. Method A search of the following electronic databases: PubMed/MEDLINE, ScienceDirect, and Web of Science. Two different authors separately tabulated the indices selected in identical predetermined forms. The methodological quality of all randomised trials was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias. Results Seven articles were finally included. The main features of interventions included online cognitive-behavioural and/or psychoeducation therapy to improve health with an interactive component. The methodological quality showed a high risk of bias, mainly from a lack of blinding. Conclusion There are indicators that suggest that internet-based interventions may be useful for women with chronic pain. However, the validity of such a conclusion is limited as most trials included had a high risk of bias. More rigorous research is required before stating that such interventions can overcome the current limitations of traditional face-to-face care.

scholarly journals Analgesic effects of physical exercise in patients with chronic musculoskeletal pain during confinement by the COVID -19 pandemic

2020 ◽  
Vol 37 (6) ◽  
pp. 393-397
Author(s):  
Jaime Salom Moreno ◽  
Sandra Sánchez Jorg ◽  
Davinia Vicente Campos ◽  
Luis A Berlanga
Keyword(s):  
Chronic Pain ◽  
Physical Exercise ◽  
Musculoskeletal Pain ◽  
Ad Hoc ◽  
Combined Therapy ◽  
Chronic Musculoskeletal Pain ◽  
Analgesic Effects ◽  
Primary Location ◽  
Type Of Exercise

Introduction:The confinement experienced during the COVID-19 pandemic in Spain for more than two months,could severely affect the condition and quality of life of patients suffering from chronic musculoskeletal pain. Taking into account the analgesic effects that physical exercise can generate, a large part of the population has carried out some kind of physical exercise at home as a mechanism for pain control, during this period. Objective:The objective of this study was to know the type and dosage of the exercise performed, as well as the perception of the patient ́s pain during the confinament period. Material and method: An ad hoc survey by a Google Form was conducted in 86 patients to find out the health status of the patients, the type of exercise they performed and the dossage of the exercise, as well as whether they had perceived a reduction in their pain during the period of confinement. Results:The pain intensity was reduced significantly (p = 0.001) when some kind of exercise was done. Strength exercise exclusively was chosen by 51% of the population, and the frequencies and session time were not significantly different bet-ween the subjects who felt a reduction in pain and those who did not. Conclusion:A schedule of physical exercise 4 days a week, for at least 50 minutes and with intensities around 77% of HR-máx of aerobic or strength training would be recommended in patients with chronic pain, as a strategy for pain reduction. The results of our study do not advise, for patients with chronic pain, combined therapy sessions, regardless of the primary location of the pain.

A Systematic Review of Assessments and Interventions for Chronic Pain in Young Children With or at High Risk for Cerebral Palsy

2021 ◽  
pp. 088307382199691
Author(s):  
Lisa Letzkus ◽  
Darcy Fehlings ◽  
Lauren Ayala ◽  
Rachel Byrne ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Cerebral Palsy ◽  
High Risk ◽  
Online Survey ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Parent Report ◽  
Medical Cannabis ◽  
Nonpharmacologic Intervention

Background: Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy. Methods: A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences. Results: Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable. Conclusion: A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.

Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1369-1376
Author(s):  
Matthew J Bair ◽  
Samantha D Outcalt ◽  
Dennis Ang ◽  
Jingwei Wu ◽  
Zhangsheng Yu
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Pain Catastrophizing ◽  
Psychological Outcomes ◽  
Stepped Care ◽  
Chronic Musculoskeletal Pain ◽  
Pain Severity ◽  
Analysis Of Covariance ◽  
Escape Trial ◽  
Care Intervention

Abstract Objective To compare pain and psychological outcomes in veterans with chronic musculoskeletal pain and comorbid post-traumatic stress disorder (PTSD) or pain alone and to determine if veterans with comorbidity respond differently to a stepped-care intervention than those with pain alone. Design Secondary analysis of data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial. Setting Six Veterans Health Affairs clinics. Subjects Iraq and Afghanistan veterans (N = 222) with chronic musculoskeletal pain. Methods Longitudinal analysis of veterans with chronic musculoskeletal pain and PTSD or pain alone and available baseline and nine-month trial data. Participants randomized to either usual care or a stepped-care intervention were analyzed. The pain–PTSD comorbidity group screened positive for PTSD and had a PTSD Checklist–Civilian score ≥41 at baseline. Results T tests demonstrated statistically significant differences and worse outcomes on pain severity, pain cognitions, and psychological outcomes in veterans with comorbid pain and PTSD compared with those with pain alone. Analysis of covariance (ANCOVA) modeling change scores from baseline to nine months indicated no statistically significant differences, controlling for PTSD, on pain severity, pain centrality, or pain self-efficacy. Significant differences emerged for pain catastrophizing (t = 3.10, P < 0.01), depression (t = 3.39, P < 0.001), and anxiety (t = 3.80, P < 0.001). The interaction between PTSD and the stepped-care intervention was not significant. Conclusions Veterans with the pain–PTSD comorbidity demonstrated worse pain and psychological outcomes than those with chronic pain alone. These findings indicate a more intense chronic pain experience for veterans when PTSD co-occurs with pain. PTSD did not lead to a differential response to a stepped-care intervention.

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