Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

Humoral Immune Durability of Anti-SARS-CoV-2 Antibodies in Southern Iran: A Population-Based Survey Study

Background: To promote mitigation strategies and public health response, this study aimed to evaluate the population-based seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in Hormozgan province. Materials and Methods: The study was conducted within 10 districts of Hormozgan province with 1325 participants for three months by considering three-month successive follow-ups to evaluate the durability of humoral immunity. The participants completed the questionnaire, and blood samples were taken followed by immunoassay SARS-CoV-2 ELISA testing. Results: In general, 717 (54.1%) males and 596 (45.9%) females participated in this study. In phase one, 147 (11.1%) and 182 (14.7%) tested positive for immunoglobulin M (IgM) and IgG, respectively. Upon three months, 13.8% and 17.8% tested positive for IgG and at least for one of the antibodies. Based on the results, 606 (45.7%) cases reported no symptoms while 673 (50.8%) of them reflected at least one. Among 798 (60.2%) participants, the most common symptoms were headache (n = 244, 18.4%), sore throat (n = 186, 14.0%), weakness (n = 150, 11.3%), muscular pain (n = 139, 10.5%), and sputum cough (n = 134, 10.1%). The odds of the antibodies in females was 1.37 (95% CI: 1.03, 1.82, P = 0.03). In phase 2, 43 (5.3%) participants persisted positive for IgG while 559 (73%) tested negative for IgG. Finally, 20% of the suffered participants tested positive for IgG until nine months. Conclusion: Although IgG antibodies decreased in the first six months, their titers persisted stable for nine months. It seems our population has not reached a desirable level of protection. It is stressed that mass vaccination is needed to prevent future epidemic waves.

Frequency of Musculoskeletal Disorders and their Counter Measures Adopted by Final Year Students and Young Dentists: A Questionnaire Based Multicenter Study

Aim: Musculoskeletal disorders have significantly been related to poor ergonomics practice during clinics. There is limited data regarding the prevalence and reasons for work-related musculoskeletal disorders in young dentists. This study was conducted to find out the prevalence of musculoskeletal disorders in young dentists, identification of the perceived reasons for musculoskeletal disorders, and measures taken to manage them. Study Design: Cross-sectional observational study. Methods: A cross-sectional study was conducted on 408 house officers from ten dental institutes of twin cities and Karachi, Pakistan. The subjects were inquired through a validated questionnaire about the presence of muscular pain, affected body regions, frequency, intensity, nature of onset, aggravating factors, and average duration of the pain episodes. They were also asked about measures taken to counter musculoskeletal pain and their effectiveness. Results: The overall prevalence of musculoskeletal disorders was n=231(56.6%) with n=172(39.2%) of participants reporting it to be work-related with a higher percentage of females n=138/172 (80.2%) The most affected body regions were the back n=101/172 (58.7%), shoulders n=91/172 (52.9%) and neck n=80/172(46.5%). Improper posture n=108(62.8%) followed by prolonged sitting n=88(51.2%) were the most common reasons perceived by the young dentists for their pain. Bed rest was adopted 93(54.1%) to alleviate pain followed by posture rectification 76(44.2%). Most n=134(77.9%) of them thought that these measures are helpful for the alleviation of pain. Conclusion: The prevalence of work-related musculoskeletal disorders among young dentists is high. The back, shoulder, and neck areas were more frequently affected. A higher percentage of females suffered from MSD as compared to males. Bed rest was the most common measure adopted to alleviate the pain. Very few of them sought professional help for their musculoskeletal disorders.

Acute otitis media and Covid-19 symptoms: a case report

Background: In December 2019, the first Coro­navirus disease 2019 (Covid-19) case was obse­rved in Wuhan, China, and afterward, the world has been exposed to an ongoing pandemic. The Covid-19 has different symptoms, such as fever, coughing, shortness of breath, muscular pain, headache, diarrhea, nose running, and a sore thr­oat. However, the symptoms of Covid-19 are not limited to these ones. The Case: The present study reports a 39-year-old female patient complaining of earache and hearing loss with no other Covid-19 symp­toms. The medical tests and diagnoses finally inferred that she was suffering from the Covid-19. Conclusion: In addition to the common symp­toms of Covid 19, acute otitis media can be con­sidered as another symptom of this disease. Keywords: Acute otitis media; Covid-19; conductive hearing loss

Effectiveness and Safety of Physical Therapy Intervention in Adult Dermatomyositis: A Case Report and Review

BACKGROUND The evidence for positive effects of exercise is insufficient in dermatomyositis. This article aims to outline the effects of physical exercise with regard to structure (Disease activity, inflammation, metabolic milieu and muscle structure) as well as clinical outcome in terms of impairment, activity limitation, participation restriction according to the ICF; and QOL in an adult patient with dermatomyositis. CASE DESCRIPTION A 47-years old female diagnosed with definite DM since last 10 months was referred by a Rheumatologist for physical therapy intervention. INTERVENTION 12 weeks (Three days a week) of Physiotherapy (Moderate intensity, individualized, closely monitored) along with a structured home exercise program (Low intensity, 5 days - 6 days a week). OUTCOME MEASURES Assessment of muscular pain, muscle strength, endurance, balance, functional evaluation, and QOL along with serological investigations. RESULTS Effectiveness Patient continued to show meaningful and clinically significant improvement on standardized outcome measures: 1. A major clinical response (total improvement score of 77) on IMAC S core set measures. 2. Improvement across all domains of ICF viz. muscle strength; endurance; movement coordination; balance; aerobic endurance; confidence and performance in activities of daily living; participation in social activities. 3. Probable disease-modifying effect: Progressively tapering dose of prescribed corticosteroids medication and improvement in disease-specific biochemical markers. 4. Patient reported measures: Reduction in muscular pain, shortness of breath & fatigue; and improvement in Healthrelated QOL. SAFETY (As evident clinically and from the investigations): 1. No adverse reaction to exercises or physical activity. 2. Remained in remission - stable disease activity. CONCLUSION Moderate intensity of physiotherapy intervention along with home exercise program is effective and safe in improving functional outcomes for dermatomyositis in a stable disease activity state. This case report enhances our understanding of the effects of physical exercise and may improve treatment and outcome in patients with dermatomyositis.

Physiotherapy in Bruxism: A Scoping Review

Background: Bruxism is a parafunctional activity comprising of spasmodic non-functional gnashing, grinding, or clenching of teeth or involuntary rhythmic movement which may cause occlusal trauma. Bruxism causes muscular pain, stiffness, jaw restriction, sleep disturbances and degraded quality of life. The awareness of bruxism in population is extremely low. Physiotherapy has proven effective in many musculoskeletal and neurological conditions as a non-pharmacological treatment. Thus, the aim of this study to explore the recent physiotherapy treatments available for the better prognosis and improved quality of life for the patient suffering from bruxism. Methodology: In this scoping review articles are researched from the search engines like PUBMED, GOOGLE SCHOLAR, etc. These articles are reviewed according to the inclusion criteria which include last 5 years of articles, experimental and clinical trials, randomized and non-randomized control trials, etc. 9 articles were selected according to it. Later the qualities of these articles were analyzed with help of PEDRO Scale. Conclusion: Pain, muscle activity reduction and increase jaw mobility are the key symptoms to be focused on by physiotherapy management. Physiotherapy has recently provided different techniques like Kinesiotaping and dry needling effective, myofascial trigger point release in reducing pain in bruxism. There are modalities like contingent electrical stimulation which help in reducing episodes, low level laser therapy reduces bruxism pain. Exercises and relaxation and PNF techniques and massage therapy all help in increasing the range of motion, strengthening, pain reduction, better oral and sleep habits. More research needs to be done on effect of different stretching on bruxism. Overall a combination of this management can provide a better and quality treatment for Bruxism. Key words: Bruxism, Physiotherapy.

Response of Knee Extensor Muscle-Tendon Unit Stiffness to Unaccustomed and Repeated High-Volume Eccentric Exercise

The purposes of this study were to investigate the muscle-tendon unit stiffness response and to compare the stiffness with those of other indirect markers induced by two bouts of unaccustomed eccentric exercise. Eleven untrained men performed two bouts of 200 maximal eccentric contractions of the right quadriceps 4 weeks apart. Changes in stiffness, pain evoked by stretching and pressure, plasma creatine kinase (CK) activity, and muscle thickness were followed for 7 days after each bout. Stiffness and pain peaked immediately and 1 day after the first exercise bout, whereas CK and thickness were highest 4 and 7 days after the first exercise bout, respectively (P < 0.05 for all). Muscular pain, thickness, and stiffness responses were lower by 53.3%, 99%, and 11.6%, respectively, after the repeated bout compared to after the first bout (P < 0.05 for all), while CK activity response did not differ significantly between bouts. High responders for an increase in muscle-tendon unit stiffness showed a repeated-bout effect for stiffness, pain, and CK activity (by 29%, 65%, and 98%, P < 0.05 for all), but the repeated-bout effect was not that clear in low responders. These findings suggest that a repeated eccentric exercise bout effect on stiffness in quadriceps is mostly not associated with muscle pain and CK activity, but there are large individual differences.

Medicinal Plants in Physical Exercise: A Review

Background: The use of medicinal plants may have an effective action on the performance of athletes. Aims: This review aimed to evaluate the effects of the use of medicinal plants and some phytocompounds on physical performance. Methodology: MEDLINE/PUBMED and EMBASE were consulted following the PRISMA guidelines. Results: Panax ginseng increases the anti-fatigue effect, decreases the stress promoted by the physical exercise, and improves muscular function through gene expression enhancement. Arnica montana has a crucial anti-inflammatory action showing relief of muscular pain a. Zingiber officinale has an anti-inflammatory and analgesic role on muscular pain, and it can be used to speed up the recovery of muscular strength after intense activity. Ephedra sinica is related to thermogenic and sympathomimetic effects, being able to increase the energetic state. Capsaicin increases the energetic expenditure due to fat oxidation, promotes the anti-fatigue effect, and enhances the athlete’s resistance. Caffeine has ergogenic importance related to its antioxidant capacity, and it improves mental alertness condition. Conclusion: The nutritional supplementation with products derived from medicinal plants may be an efficient alternative to improve the athlete’s performance, being a natural substitute for synthetic supplements, which usually are forbidden in competitions.

Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection

Background Characterizing the prevalence and persistence of symptoms associated with COVID-19 infection following hospitalization and their impact is essential to planning post-acute community-based clinical services. This study seeks to identify persistent COVID-19 symptoms in patients 35 days post-hospitalization and their impact on quality of life, health, physical, mental, and psychosocial function. Methods and findings This prospective cohort study used the PROMIS® Instruments to identify symptoms and quality of life parameters in consecutively enrolled patients between March 22 and April 16, 2020, in New Jersey. The 183 patients (median age 57 years; 61.5% male, 54.1% white) reported persistent symptoms at 35 days, including fatigue (55.0%), dyspnea (45.3%), muscular pain (51%), associated with a lower odds rating general health (41.5%, OR 0.093 [95% CI: 0.026, 0.329], p = 0.0002), quality of life (39.8%; OR 0.116 [95% CI: 0.038, 0.364], p = 0.0002), physical health (38.7%, OR 0.055 [95% CI: 0.016, 0.193], p <0.0001), mental health (43.7%, OR 0.093 [95% CI: 0.021, 0.418], p = 0.0019) and social active role (38.7%, OR 0.095 [95% CI: 0.031, 0.291], p<0.0001), as very good/excellent, particularly adults aged 65 to 75 years (OR 8·666 [95% CI: 2·216, 33·884], p = 0·0019). Conclusions COVID-19 symptoms commonly persist to 35 days, impacting quality of life, health, physical and mental function. Early post-acute evaluation of symptoms and their impact on function is necessary to plan community-based services.

Local Vibratory Stimulation for Temporomandibular Disorder Myofascial Pain Treatment: A Randomised, Double-Blind, Placebo-Controlled Preliminary Study

Several methods are currently used to manage pain related to temporomandibular disorder (TMD). Vibratory stimulation is applied as a pain treatment for several musculoskeletal disorders, but it has not yet been studied in-depth for TMD symptoms. The aim of this study is to analyse the effectiveness of at-home local vibration therapy (LVT) for the management of TMDs-related myofascial pain. Methods. Fifty-four TMD patients (43 F, 11 M) with an average age of 40.7 (age range: 29–54 yr.) were randomly subdivided into two groups. The study group (AG) received 1 week of at-home LVT treatment with the NOVAFON Pro Sk2/2 : 50/100 Hz, bilaterally applied to the pain area for 16 minutes daily. The placebo group (IG) followed the same protocol using inactive devices. Temporomandibular joint pain (TMJ), muscular pain (MM), and headache (HA) were assessed. Pain was evaluated using the visual analogue scale (VAS) before (T0) and after therapy (T1). Statistical analysis and Student’s t-tests were applied (statistical significance for P < 0.05 ). Results. AG patients reported decreased average values for all types of pain considered between T0 and T1, with a statistically significant difference for TMJ pain ( P < 0.05 ), MM pain, and HA ( P < 0.001 ). IG patients reported a no statistically significant decrease in the average values of MM pain and an increase in the average values of TMJ pain and HA. Conclusion. The study supports the use of local vibration therapy in the control of TMD-related TMJ pain, local muscular pain, and headache.