Musculoskeletal pain related to COVID-19 survivors after hospitalization: A short review (Dolor musculoesquelético en supervivientes del COVID-19 tras la hospitalización: Una breve revision)

Objective: This review aimed to provide an update on the characterization and impact of musculoskeletal pain in COVID-19 survivors. Methods: It is considered articles on subjects who had been recovered from COVID-19 infection after hospitalization (COVID-19 survivors) with secondary musculoskeletal pain. Results: Six articles (one editorial, one consensus statement, one letter to the editor, one case-control study, one cohort study and one review) showed the polyhedral effects of the SARS-CoV-2 on musculoskeletal pain. This short review was not able to clearly identify what the pathogenesis of musculoskeletal pain was in COVID-19 survivors. Conclusion: Preliminary data showed that widespread pain similar to the pattern compatible with pain of musculoskeletal origin could characterize symptoms after SARS-CoV-2 infection. Resumen. Objetivo: Esta revisión tuvo como objetivo proporcionar una actualización sobre la caracterización y el impacto del dolor musculoesquelético en los supervivientes de COVID-19. Métodos: Se consideraron artículos sobre sujetos que se recuperaron de la infección por COVID-19 tras la hospitalización (supervivientes de COVID-19) con dolor musculoesquelético secundario. Resultados: Seis artículos (un editorial, una declaración de consenso, una carta al editor, un estudio de casos y controles, un estudio de cohortes y una revisión) mostraron los efectos poliédricos del SARS-CoV-2 sobre el dolor musculoesquelético. Esta breve revisión no pudo identificar claramente cuál era la patogénesis del dolor musculoesquelético en los supervivientes del COVID-19. Conclusión: Los datos preliminares mostraron que el dolor generalizado similar al patrón compatible con el dolor de origen musculoesquelético podría caracterizar los síntomas después de la infección por SARS-CoV-2.

Free-Living User Perspectives on Musculoskeletal Pain and Patient-Reported Mobility With Passive and Powered Prosthetic Ankle-Foot Components: A Pragmatic, Exploratory Cross-Sectional Study

IntroductionStudies with a powered prosthetic ankle-foot (PwrAF) found a reduction in sound knee loading compared to passive feet. Therefore, the aim of the present study was to determine whether anecdotal reports on reduced musculoskeletal pain and improved patient-reported mobility were isolated occurrences or reflect a common experience in PwrAF users.MethodsTwo hundred and fifty individuals with transtibial amputation (TTA) who had been fitted a PwrAF in the past were invited to an online survey on average sound knee, amputated side knee, and low-back pain assessed with numerical pain rating scales (NPRS), the PROMIS Pain Interference scale, and the PLUS-M for patient-reported mobility in the free-living environment. Subjects rated their current foot and recalled the ratings for their previous foot. Recalled scores were adjusted for recall bias by clinically meaningful amounts following published recommendations. Statistical comparisons were performed using Wilcoxon's signed rank test.ResultsForty-six subjects, all male, with unilateral TTA provided data suitable for analysis. Eighteen individuals (39%) were current PwrAF users, whereas 28 subjects (61%) had reverted to a passive foot. After adjustment for recall bias, current PwrAF users reported significantly less sound knee pain than they recalled for use of a passive foot (−0.5 NPRS, p = 0.036). Current PwrAF users who recalled sound knee pain ≥4 NPRS with a passive foot reported significant and clinically meaningful improvements in sound knee pain (−2.5 NPRS, p = 0.038) and amputated side knee pain (−3 NPRS, p = 0.042). Current PwrAF users also reported significant and clinically meaningful improvements in patient-reported mobility (+4.6 points PLUS-M, p = 0.016). Individuals who had abandoned the PwrAF did not recall any differences between the feet.DiscussionCurrent PwrAF users reported significant and clinically meaningful improvements in patient-reported prosthetic mobility as well as sound knee and amputated side knee pain compared to recalled mobility and pain with passive feet used previously. However, a substantial proportion of individuals who had been fitted such a foot in the past did not recall improvements and had reverted to passive feet. The identification of individuals with unilateral TTA who are likely to benefit from a PwrAF remains a clinical challenge and requires further research.

Genome-wide association study of nociceptive musculoskeletal pain treatment response in UK Biobank

Drug treatment for nociceptive musculoskeletal pain (NMP) follows a three-step analgesic ladder proposed by the World Health Organization (WHO), starting from non-steroidal anti-inflammatory drugs (NSAIDs), followed by weak or strong opioids until the pain is under control. However, effective pain treatment is challenged by inter-individual differences, and unsatisfied pain treatment response (PTR) rates ranging from 34 to 79% in those suffering from NMP. To investigate the underlying genetic component of PTR, we performed a genome-wide association study (GWAS) in ~ 23,000 participants with NMP from the UK Biobank. In our primary analysis, we compared NSAID vs. opioid users as a reflection of (non)response to NSAIDs, adjusting for age, sex, BMI, population substructure, and study-specific covariates. One genome-wide significant hit was identified in an intergenic region on chromosome 4, rs549224715 (P = 3.88x10-8), and seven signals pass the suggestively significant threshold (P < 1x10-6). All identified loci were in non-coding regions, but most variants showed potential regulatory functions. SNPs in LD (r2 > 0.6) with the lead SNPs passing the nominal significant threshold (P < 0.05) were mapped to 28 target genes in FUMA. Eight of these 28 genes are involved in processes linked to neuropathic pain and musculoskeletal development. Pathway and network analyses with Ingenuity resulted in the identification of immunity-related processes and a (putative) central role of EGFR. Genetic correlation analysis including 596 traits resulted in the identification of 67 nominally significant (P < 0.05) genetic correlations, and these traits were significantly enriched for chronic pain and socioeconomic status traits (P = 3.35 x 10-12). Additionally, we conducted a subtype GWAS for inflammatory NMP and a secondary GWAS for participants with NMP disease history, but no significant hits or overlap with the primary analysis were observed. Overall, we identified one genome-wide significant association in this first GWAS focusing on pain treatment using the analgesic ladder as phenotype. However, we realize that this study lacked power and should be viewed as a first step to elucidate the genetic background of NMP treatment.

Correlations between body postures and musculoskeletal pain in guitar players

Background The guitar-playing community is the largest group at risk of developing playing related musculoskeletal disorders. A thorough investigation of the relationships between the various risk factors and players’ report on musculoskeletal pain using objective and accurate means of assessment has yet to be reported. Purpose (a) to explore the correlations between demographic characteristics, anthropometric measurements, playing habits, and personal habits of guitar player and their complaints of musculoskeletal pain, (b) explore the correlations between the upper body kinematics of guitar players during playing the guitar and their complaints of musculoskeletal pain, and (c) compare the upper body kinematics of guitar players during playing the guitar while sitting versus standing. Methods Twenty-five guitar players (27.5±4.6 years old) filled out questionnaires regarding their guitar-playing habits, and the Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. Kinematics of their torso and upper limbs were tracked while they played a tune twice, once while sitting and once while standing. Results We found moderate correlations between the number of painful joints in the last year and factors, such as physical comfort while playing, years of playing, and position during playing. During standing, lower back pain severity correlated with the rotation range of the torso, while during sitting, it moderately correlated with the average radial-ulnar deviation of the right wrist. During sitting, we found higher anterior and right tilt of the torso, combined with greater abduction of the right shoulder, higher flexion in the left shoulder and higher radial deviation in the left wrist. Conclusion Our results point to several risk factors, related both to playing habits but also to playing posture, which should be considered by the guitar players in order to prevent playing-related musculoskeletal disorders.

Asociación entre el peso de mochilas escolares con el modo de desplazamiento al colegio y dolor musculoesquelético

The aims of this study were; 1- Analyze the mode of commuting of the school children to school, the weight and type of school bags they were carrying and musculoskeletal pain separately by sex. 2- Analyze the association between weights of school bags with mode of commuting to school. A total of 76 children (8.8 ± 0.3 years, 50% children) participated in the study. The Pediatric Pain questionnaire was used to determine the presence or absence of pain. The PACO questionnaire was used to know the mode of commuting to school. The results showed that the active commuting were higher in boys than girls (p =0.042). In addition, there was a significant association between meeting the school bags weight recommended and active commuting from school to home (OR =3.88, p =0.039). Meeting with the weight of the school bags recommended may favor the non-appearance of musculoskeletal pain and active commuting to school. Los objetivos del estudio fueron; 1- Analizar el modo de desplazamiento de los escolares al colegio, el peso y tipo de mochilas transportadas y dolores músculos-esqueléticos diferenciados por sexo. 2- Analizar la asociación entre el peso de las mochilas con el modo de desplazamiento al colegio. Un total de 76 escolares (8.8±0.3 años, 50% niños) participaron en el estudio. El cuestionario Pediátrico de Dolor sirvió para determinar la presencia o no de dolor. El cuestionario PACO fue utilizado para determinar el modo de desplazamiento al colegio. Los resultados indicaron que las niños se desplazaron más de forma activa que los niñas (p =0.042). Además, existió una asociación significativa entre cumplir con el peso recomendado de las mochilas y el desplazamiento activo del colegio al hogar (OR =3.88, p =0.039). Cumplir con el peso recomendado de las mochilas está asociado a la ausencia de dolor musculo-esquelético y el desplazamiento activo al colegio.