Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis

BACKGROUND

A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined.

OBJECTIVES

The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain.

METHODS

For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain.

CONCLUSIONS

Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.

COVID-19: Assessing the impact of lockdown on recreational athletes

BACKGROUND AND AIMS

The COVID-19 pandemic has resulted in associated lockdown restrictions for individuals across England, including the postponement of all recreational sporting provisions. The beneficial effects of regular physical activity are well established yet to the authors' knowledge, no research addresses the cancellation of all recreational provisions. Using quantitative and qualitative methods, this study assessed the impact of COVID-19 restrictions on recreational sports players, what alternative exercise methods have been sought and how players feel about returning to their sport.

METHOD

An online survey was distributed across England for six-weeks commencing in May 2020. A questionnaire explored differences in the impact of COVID-19 restrictions between sex, winter/summer/year-round sports, team/individual sports, age, and resilience groups. The use of alternative exercise methods, coping strategies and feelings about returning to sport were also investigated. Responses were gathered from 2023 adults whose recreational sport had been cancelled by COVID-19. All completed questionnaires (n = 1213) were taken for analysis (mean age = 49.41 years, SD = 17.165, 55.2% female).

RESULTS

Quantitative findings showed the negative impact of COVID-19 restrictions was greater for females, those involved in winter and team sports, those aged 18-39 and low-resilient copers (p < .05). No significant differences were found between individuals that had had COVID-19 or were considered vulnerable by government guidelines. Acceptance was the most common coping strategy. The average number of days per week that participants exercised significantly increased during lockdown, with significant increases also seen in the use of online workouts, fitness apps and home-gym exercise. Qualitative findings suggested that participants are looking forward to the social and physical benefits of recreational activity restarting yet are concerned about the logistics of returning under social distancing restrictions. Other worries included loss of fitness, spreading (younger age groups) and catching (older age groups) COVID-19 and being in a crowd.

CONCLUSIONS

Results highlight what is currently accessible to home-based exercisers and inform the reintroduction of recreational sports clubs. As COVID-19 restrictions look to persist, club representatives should provide accessible home-exercise options and be cautious of participant concerns when considering the return of recreational sport.

Effect of hyperglycaemia on muscarinic M3 receptor expression and secretory sensitivity to cholinergic receptor activation in islets

AIMS

Islets are innervated by parasympathetic nerves which release acetylcholine (ACh) to amplify glucose-induced insulin secretion, primarily via muscarinic M3 receptors (M3R). Here we investigate the consequence of chronic hyperglycaemia on islet M3R expression and secretory sensitivity of mouse islets to cholinergic receptor activation.

METHODS

The impact of hyperglycaemia was studied in (i) islets isolated from ob/ob mice, (ii) alginate-encapsulated mouse islets transplanted intraperitoneally into streptozotocin-induced diabetic mice and (iii) mouse and human islets maintained in vitro at 5.5 or 16 mmol/l glucose. Blood glucose levels were assessed by a commercial glucose meter, insulin content by RIA and M3R expression by qPCR and immunohistochemistry.

RESULTS

M3R mRNA expression was reduced in both ob/ob islets and islets maintained at 16 mmol/l glucose for 3 days (68 and 50% control, respectively). In all three models of hyperglycaemia the secretory sensitivity to the cholinergic receptor agonist, carbachol, was reduced by 60-70% compared to control islets. Treatment for 72 h with the irreversible PKC activator, PMA, or the PKC inhibitor, Gö6983, did not alter islet M3R mRNA expression nor did incubation with the PI3K-inhibitor, LY294002, although enhancement of glucose-induced insulin secretion by LY294002 was reduced in islets maintained at 16 mmol/l glucose, as was mRNA expression of the PI3K regulatory subunit, p85α.

CONCLUSIONS

Cholinergic regulation of insulin release is impaired in three experimental islet models of hyperglycaemia consistent with reduced expression of M3 receptors. Our data suggest that the receptor downregulation is a PKC- and PI3K-independent consequence of the hyperglycaemic environment, and they imply that M3 receptors could be potential targets in the treatment of type 2 diabetes.