What Is New in Classification, Diagnosis and Management of Chronic Musculoskeletal Pain: A Narrative Review

Psychometric Properties of the Arabic Version of the Pain Resilience Scale among Lebanese Adults with Chronic Musculoskeletal Pain

Background

The Pain Resilience Scale (PRS), which measures behavioral perseverance and the ability to regulate emotions and cognition despite ongoing pain, lacks an Arabic version.

Objectives

This study aimed to translate, culturally adapt, and validate an Arabic version of the Pain Resilience Scale (PRS-A) among Lebanese adults.

Methods

Phase 1 involved translation and cross-cultural adaptation of the PRS into Arabic. Phase 2 examined the reliability and validity of the PRS-A. A convenience sample of 154 Lebanese adults with chronic musculoskeletal pain completed the PRS-A and self-report measures of pain catastrophizing, pain self-efficacy, pain intensity and interference, depression and anxiety, and quality of life.

Results

The PRS-A yielded a two-factor structure with factor 1 representing "cognitive/affective positivity" and factor 2 representing "behavioral perseverance," accounting for 41.93% and 15.15% of the variance in pain resilience, respectively. Total PRS-A score (M = 33.20 and SD = 9.90) showed significant correlations with pain catastrophizing (M = 27.65, SD = 13.03, and r = -0.52), pain self-efficacy (median = 9.00, IQR = 4, and rho = 0.61), pain intensity (M = 4.50, SD = 2.25, and r = -0.28), pain interference (M = 4.30, SD = 2.89, and r = -0.56), physical (M = 34.95, SD = 9.52, and r = 0.34) and mental (M = 40.08, SD = 12.49, and r = 0.58) health functioning, anxiety (median = 7.00, IQR = 7, and rho = -0.57), and depression (median = 4.00, IQR = 6, and rho = -0.58). PRS-A subscale was also significantly related to all measures except pain intensity, which was correlated with cognitive/affective positivity (r = -0.33) but not behavioral perseverance (r = -0.09). Cronbach's alpha for the PRS-A was 0.87.

Conclusion

The PRS-A demonstrated validity and acceptable reliability among Arab-speaking individuals with chronic musculoskeletal pain, suggesting its potential utility for assessing pain resilience within this population.

Systematic Review of the Psychopathological Symptomatology and Neuropsychological Disorders of Chronic Primary Musculoskeletal Pain

Chronic pain can develop without tissue damage, injury, or underlying illness. There are several intervening biological, psychological, and social factors involved in its appearance that significantly affect the activities of daily life. It is also associated with significant emotional anxiety and/or functional disability. This review systematically analyses works published in the last five years that evaluate the psychopathological symptomatology and neuropsychological disorders of chronic primary musculoskeletal pain (CPMP). A bibliographic search was carried out to identify articles published in English between January 2018 and March 2023 using the Medline, Scopus, PsycInfo, and Pubmed databases. Twenty articles were obtained using the PRISMA selection method. The main results of this study provided evidence of the presence of moderate and severe chronic pain in patients suffering from musculoskeletal pain. This increase in the intensity of pain correlates with greater psychopathological symptomatology, such as depression, anxiety, insomnia, lack of attention, and hyperactivity/impulsiveness, as well as the use of maladaptive coping strategies. Furthermore, there exists dysfunction in the cerebral structures related to attention and the processing of pain in patients with CPMP. This review may help to develop and optimise the multidisciplinary treatments adapted to the deficits caused by this illness.

Maintaining resilience over time: A qualitative exploration of the experiences of living with chronic musculoskeletal pain

BACKGROUND

Living with chronic pain can have several negative consequences. However, some individuals are more resilient despite pain. Although a large body of research exploring resilience-enhancing factors exists, there is a lack of research focused on the changes of individual's resilience over time.

OBJECTIVES

This study aims to explore how people with chronic musculoskeletal pain (CMP) describe their experience regarding the maintenance of resilience in the long term.

METHODS

Within the framework of the qualitative research strategy, semi-structured interviews and two focus groups with 17 purposefully selected research participants (ages 29-64) were conducted. The data were analysed by integrating thematic analysis and narrative analysis.

RESULTS

To maintain resilience in the long term, it is important to take responsibility for one's physical and mental well-being by practicing regular ability-adjusted physical activity, giving up unrealistic expectations, focussing on finding opportunities, not obstacles, maintaining a positive future perspective, and finding significance in life despite experiencing chronic pain. Financial support from the government and access to rehabilitation can facilitate better self-care for those with limited finances.

CONCLUSION

This study may be useful for healthcare professionals, psychologists, social workers, and other specialists who daily encounter patients with CMP and aspire to understand the main challenges and needs of this particular group of patients.

Perceived discrimination and problematic opioid use among Black individuals with chronic musculoskeletal pain

OBJECTIVE

Chronic musculoskeletal pain (CMP) is prevalent, burdensome, and associated with an increased risk for opioid use disorder. Evidence suggests that perceived racial/ethnic discrimination is associated with problematic substance use among Black individuals, but studies have not focused on problematic opioid use among Black individuals with CMP specifically or explored the contribution of perceived discrimination, pain intensity, and pain-relevant psychological factors to this association.

METHOD

We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP and prescription opioid use. We tested whether perceived discrimination (a) was associated with self-reported problematic opioid use and (b) explained unique variance in this outcome after accounting for pain intensity, demographic factors, and psychological factors previously implicated in problematic opioid/substance use (distress tolerance and pain avoidance).

RESULTS

Hierarchical linear regression analysis revealed that our model as a whole explained significant variance in problematic opioid use, R² = .30, F(6, 394) = 28.66, p < .001. Perceived discrimination specifically was associated with more problematic opioid use (β = .39, SE = .05, p < .001) and explained unique variance in this outcome even after accounting for pain intensity (β = .06, SE = .04, p = .20), distress tolerance (β = -.10, SE = .05, p = .04), pain avoidance (β = .12, SE = .05, p = .02), age (β = -.10, SE = .05, p < .05), and employment status (β = .13, SE = .11, p < .01).

CONCLUSIONS

Systemic efforts to combat racism along with individualized therapeutic approaches to process and cope with perceived racial discrimination may be particularly important to prevent and reduce problematic opioid use among Black individuals with CMP. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Association Between Musculoskeletal Pain and Frailty Over Time in Older Adults

BACKGROUND AND PURPOSE

There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults.

PARTICIPANTS AND METHODS

A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year follow-ups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years.

RESULTS

After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05).

CONCLUSIONS

Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.

Musculoskeletal and Neuropathic Pain in COVID-19

Chronic pain constitutes a significant disease burden globally and accounts for a substantial portion of healthcare spending. The COVID-19 pandemic contributed to an increase in this burden as patients presented with musculoskeletal or neuropathic pain after contracting COVID-19 or had their chronic pain symptoms exacerbated by the virus. This extensive literature review analyzes the epidemiology of pain pre-pandemic, the costs associated with the COVID-19 pandemic, the impact of the virus on the body, mechanisms of pain, management of chronic pain post-pandemic, and potential treatment options available for people living with chronic pain who have had or are currently infected with COVID-19.

Efficacy of ozone injections for reducing musculoskeletal pain in comparison with corticosteroid injections: A systematic review and meta-analysis

BACKGROUND

Corticosteroid injections are frequently used in the short-term treatment of musculoskeletal pain, but their use is controversial as repeated exposures to corticosteroids can lead to deleterious effects on musculoskeletal tissue. Ozone injections have been proposed as a possible treatment for musculoskeletal pain; however, their effectiveness has not been compared with corticosteroids.

OBJECTIVE

To evaluate the effectiveness of ozone injections for reducing pain in individuals with musculoskeletal pain in comparison with corticosteroid injections through a meta-analysis.

METHODS

An online systematic search was performed using electronic databases up to September 2023. We searched for studies that compared corticosteroid injections with ozone injections in the treatment of musculoskeletal pain of diverse origins.

RESULTS

Eleven studies were included comprising a total of 534 individuals. In the overall pooled analysis, a pain reduction in favor of corticosteroid injections was found in the short term (d= 0.31, 95% CI 0.01 to 0.60, p (z) 0.04, I2 = 32%). In the medium term, no significant differences were found in reducing pain between groups (d=-0.17, 95% CI -0.42 to 0.07, p (z) 0.15, I2 = 0%).

CONCLUSIONS

Our results suggest that corticosteroids injections are more effective in reducing musculoskeletal pain in the short term, but equally effective in the medium term when compared with ozone injections. Nonetheless, better-quality clinical trials are necessary to corroborate these results.

Musculoskeletal Pain Management and Thermotherapy: An Exploratory Analysis of Italian Physicians' Attitude, Beliefs, and Prescribing Habits

Purpose

In Italy, musculoskeletal (MSK) disorders are pervasive with one-third of adults seeking medical consultation for a MSK issue in the past year. MSK pain is often treated with local heat applications (LHAs) which can be integrated into MSK care by different specialists and in different settings. Compared to analgesia and physical exercise, LHAs have been less evaluated, and the quality of randomized clinical trials is generally low. The aim of the survey is to assess the knowledge, attitude, perception/practices of general practitioners (GPs), physiatrists and sports medicine doctors towards thermotherapy as delivered by superficial heat pads or wraps.

Patients and Methods

The survey was conducted between June and September 2022 in Italy. An online questionnaire with 22 multiple-choice questions was administered to explore the demographics and prescribing habits of the participants; the clinical profile of MSK patients; and physicians' attitude and beliefs about the use of thermotherapy/superficial heat applications in MSK pain management.

Results

GPs are at the forefront of the MSK patient journey and preferentially select NSAIDs as first-line option in arthrosis, muscle stiffness, and strain while prescribing heat wraps as preferred choice in presence of muscle spasm/contracture. Similar pattern of prescribing habits was found among specialists who, in contrast to GPs, adopted more frequently ice/cold therapy to relieve pain due to muscle strain and limited paracetamol use. Generally, survey participants agreed on the benefits of thermotherapy in MSK care management, namely increased blood flow and local tissue metabolism as well as connective tissue elasticity and pain relief which all may be of help in attaining pain control and improvement of function.

Conclusion

Our findings provided the basis for further investigations aimed at optimizing the MSK patient journey while building up additional evidence supporting the benefit of using superficial heat applications to effectively manage patients with MSK disorders.