Role of Nutrition in the Management of Patients with Chronic Musculoskeletal Pain

Chronic musculoskeletal pain (CMP), defined as persistent discomfort in musculoskeletal tissues persisting for over 3 months, afflicts an estimated 1.71 billion people globally, leading to significant functional impairments and psychological distress, thereby detrimentally affecting individuals' quality of life. The objective of this narrative review is to elucidate the complex relationship among dietary habits, sarcopenia, and gut microbiota composition, with an eye toward enhancing patient management and outcomes. Given the burgeoning interest in the influence of diet on CMP, a detailed examination of the current literature is warranted. Nutritional intake is a critical determinant of the gut microbiota profile, which, in turn, is linked to musculature integrity and performance, potentially leading to sarcopenia. The development of sarcopenia can aggravate CMP owing to diminished muscular strength and functionality. Additionally, disruptions in the gut microbiota may directly modulate nociception, intensifying CMP manifestations. Thus, nutritional optimization emerges as a viable approach to CMP management. Emphasizing a diet conducive to a healthy gut microbiome could forestall or mitigate sarcopenia, thereby attenuating CMP intensity. Nevertheless, the domain calls for further empirical exploration to unravel the nuances of these interactions and to forge efficacious dietary strategies for individuals with CMP. Beyond mere analgesia, comprehensive patient care for CMP requires acknowledgment of the complex and multifactorial nature of pain and its foundational elements. Embracing an integrative treatment model allows healthcare practitioners to promise better patient prognoses, enriched life quality, and a decrease in the sustained healthcare costs associated with CMP.

Auriculotherapy for reducing chronic spinal pain in health workers: a clinical trial

OBJECTIVE

to evaluate the effectiveness of auriculotherapy in reducing chronic musculoskeletal pain in the spine of health workers.

METHOD

a randomized, triple-blind clinical trial conducted with health workers diagnosed with chronic spinal pain. Eight sessions of auriculotherapy with seeds were applied, two per week. The outcomes were measured with the Numerical Pain Scale, Brief Pain Inventory, Rolland-Morris Disability Questionnaire and SF-36 instruments, in the 1st, 4th and 8th session, and in the 15-day follow-up period. Descriptive and inferential analyses were performed.

RESULTS

34 workers took part in the Intervention Group and 33 in the Control Group, and both presented reduced pain intensity (p>0.05). In the follow-up period, there was a greater reduction in the Intervention Group (3.32 ± 0.42), when compared to the Control Group (5.00 ± 0.43) (p=0.007). In quality of life, there was improved vitality (p=0.012) and limitation due to emotional aspects (p=0.025). The relationship between auriculotherapy, physical disability and pain interference did not differ between the groups (p>0.05). Medication use in the follow-up period remained unchanged in the Control Group (77.8%) when compared to the Intervention Group (22.2%) (p=0.013).

CONCLUSION

auriculotherapy exerted the same effect between the groups on pain intensity, lasting longer in the follow-up period. There was an improvement in quality of life and a reduction in medication use. REBEC: RBR-3jvmdn.

Wellness of patients with chronic pain is not only about pain intensity

OBJECTIVE

Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients.

DESIGN

A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T₀ ), six (T₆ ), and twelve (T₁₂ ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively.

RESULTS

Participants included 510 patients. All variables were significantly improved from T₀ to T₆ and T₁₂ . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T₀ , T₆ , and T₁₂ (related conditions: β₀  = 0.55, p < 0.001; β₆  = 0.54, p < 0.001; and β₁₂  = 0.51, p < 0.001; pain: β₀  = 0.42, p < 0.001; β₆  = 0.18, p < 0.001; and β₁₂  = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness.

CONCLUSION

Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.

Nurses Experience and Perceived Challenges of Using Nonpharmacological Pain Interventions for Musculoskeletal Pain: A Qualitative Study

Introduction

Current musculoskeletal pain management guidelines encourage utilizing nonpharmacological pain measures. Despite their positive effect in alleviating musculoskeletal pain, nurses reported negative attitudes toward utilizing nonpharmacological pain measures. Therefore, assessing nurses' perception of nonpharmacological pain measures is essential to promote patient comfort.

Objective

The aim of the study was to explore the nurses' experience and perceived challenges in using nonpharmacological pain measures in caring for patients with musculoskeletal pain.

Materials & Methods

A descriptive qualitative design was carried out. Face-to-face semistructured interviews were conducted among 11 nurses. Colaizzi's method was employed in analyzing the data.

Results

Four themes emerged, namely, constant monitoring and observation, selection of nonpharmacological pain measures, and various barriers related to patients and nurses. One of the ways to overcome these barriers or challenges, we should promote interprofessional teams in planning patient-centered pain management care. Also, defining the role of the pain management nurse would be pivotal to ensuring effective pain management measures.

Conclusion

The nursing workforce needs to initiate and utilize these measures as a common practice in managing musculoskeletal pain and in turn create a culture that strongly supports the utilization of nonpharmacological pain measures.

Self-Reiki, Consideration of a Potential Option for Managing Chronic Pain during Pandemic COVID-19 Period

While the world faces an unprecedented situation with the pandemic, other chronic diseases such as chronic pain continue to run their course. The social distancing and restrictive displacement imposed by the pandemic situation represents a new barrier to access to pain management and tends to reinforce chronification process. Given this context, complementary and alternative medicine (CAM) might offer new opportunities to manage CP, notably with a hand-touch method, such as self-Reiki therapy. Although Reiki administered by a practitioner has shown promising results to reduce pain and psychological distress, and to improve quality of life, self-Reiki practice needs evidence-based medicine to be disseminated. Overall, self-Reiki could bring positive results in addition to, and without interfering with, conventional medicine approaches in patients experienced chronic pain.

Pain characteristics and quality of life of breast cancer survivors that return and do not return to work: an exploratory cross-sectional study

Purpose: the aim of this study is two-fold: 1) to explore the pain characteristics among breast cancer survivors that return to work and do not return to work; 2) to identify the factors associated with pain on the upper quadrant of the affected side.Materials and methods: Sixty-two breast cancer survivors were included. Quality of life was assessed using EORTC QLQ-C30 and QLQ-BR23. Pain characteristics were assessed with a body diagram and a numeric rating scale.Results: Thirty-five breast cancer survivors did not return to work. Ninety-one percent of women that did not return to work reported pain. The most frequent pain sites were the cervical spine and the axilla of the affected side. There were no significant differences in pain intensity between groups. The factors associated with pain on the upper quadrant of the affected side were perception of shoulder stiffness OR = 5.93 (1.38-44.87, 95%CI) and time since surgery of more than four years OR = 5.54 (1.36-20.97, 95% CI).Conclusions: Pain was highly prevalent among breast cancer survivors. Breast cancer survivors that returned to work presented better quality of life. Longer time since surgery and perception of shoulder stiffness were associated with pain on the upper quadrant of the affected side.Implications for rehabilitationPain is a major factor following breast cancer surgery preventing returning to work.This group reported more pain on the cervical spine and axilla of the affected side.Rehabilitation needs to focus specifically on pain management in order to improve quality of life.A multidisciplinary approach involving pain specialists and vocational support is recommended.

Effectiveness of autogenic training on psychological well-being and quality of life in adults living with chronic physical health problems: a protocol for a systematic review of RCT

BACKGROUND

Autogenic training is a relaxation technique that uses systematic exercises to induce a general disconnection of the organism. It is used in conjunction with conventional medical care as part of disease management to relieve symptoms associated with chronic health problems and to improve well-being. The purpose of this systematic review is to evaluate the efficacy of autogenic training on psychological well-being, quality of life, and adverse effects in people living with chronic physical health problems.

METHODS

The methodology used follows the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Studies, published up to December 31, 2019, will be identified through searches in the following databases: MEDLINE, Web of Science, EMBASE, SCOPUS, PsychINFO, CINAHL, EBM Reviews, Google Scholar, Dissertations & Theses Global, Open Access Theses and Dissertations, OpenGrey, E-Theses Online Service, Grey Literature Report, eScholarship@McGill, Papyrus, and CorpusUL. All studies of randomized controlled trials that assess autogenic training as an intervention to improve psychological well-being and quality of life in adults aged 18 and older living with one or more chronic physical health problem will be considered eligible. The study selection, the data collection, and the evaluation of the risk of bias will be conducted independently and in duplicate by two reviewers. RoB 2 tool will be used to assess the risk of bias. Discrepancies will be resolved through discussion. A tabular and narrative synthesis of data is planned, and a meta-analysis will be done according to the quality of data. The primary outcomes will be general psychological distress, depression, and anxiety, and the secondary outcomes will be quality of life and adverse effects. The present protocol of systematic review is reporting following MECIR standards for the reporting of protocols and the PRISMA-P recommendations.

DISCUSSION

Autogenic training appears to be a promising therapy to improve psychological well-being and quality of life in people living with chronic physical health problems, but no recent reports have synthesized the available evidence in this population. The results of this review will examine and synthesize the evidence on the benefits and harms of autogenic training on psychological well-being and quality of life in people living with chronic physical health problems, thus supporting the development of best practices for complementary approaches.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018105347.