High prevalence of musculoskeletal pain in individuals with severe obesity: sites, intensity, and associated factors

Comparison of time-matched aerobic, resistance or combined exercise training in women living with obesity: The EXOFFIT study

Background

Improvements in cardiorespiratory fitness (CRF) have been shown to largely attenuate the negative health risks associated with obesity. To date, literature on women with obesity has focused upon the evaluation of aerobic-based exercise interventions. Hence, there is a need to evaluate resistance and combined interventions with this cohort.

Objective

This study aimed to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for improving CRF, strength, body composition and other health outcomes.

Methods

Sixty-seven women with obesity were randomly assigned to the control (CON) or one of three exercise groups (aerobic [AE], resistance [RE], COM). Exercise groups were trained x3 times/week for 12 weeks (up to 150-min/week). Feasibility outcomes included adherence, attendance, recruitment and retention rates and adverse events. Secondary outcomes were CRF (predicted VO2 max), body composition (body weight [BW], waist circumference [WC], body fat percentage [%BF], fat mass [FM] and lean mass) and strength (5RM bench press, leg dynamometry, grip strength) and self-reported measures of physical activity, mood, sleep, pain and quality of life.

Results

Findings support the feasibility of all three exercise modalities in terms of adherence, attendance, and retention. Interventions with a resistance component (COM and RE) were associated with the greatest improvements across the broad range of health outcomes measured. Combined was the most promising for body composition outcomes including body mass index (Effect size [ES] = 0.79, p = 0.04), BW (ES = 0.75, p = 0.05), %BF (ES = 0.77, p = 0.04), FM (ES = 0.83, p = 0.03) and WC (ES = 0.90, p = 0.02), physical activity (i.e., moderate physical activity [ES = 0.69, p = 0.07), mood (ES = 0.83, p = 0.03) and sleep (ES = 0.78, p = 0.04). Resistance was most promising for CRF (ES = 1.47, p = 0.002), strength (i.e., bench press [ES = 2.88, p=<0.001]) and pain (i.e., pain severity [ES = 0.40, p = 0.31]).

Conclusions

For health outcomes, these results indicate the importance of including a resistance component when prescribing exercise for women with obesity to achieve meaningful improvements.

CLINICAL TRIAL REGISTRATION

ISRCTN13517067.

High prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among obese young patients - A retrospective observational study

OBJECTIVE

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of ligaments and entheses, and most commonly affects the spinal column. The prevalence of DISH is increasing with age and is considered uncommon before the age of 50 years, with an estimated prevalence of less than 5 %. DISH is known to be highly associated with metabolic syndrome and obesity. We aim to assess the prevalence of DISH among young (≤50 yr.) patients suffering from severe obesity (BMI of 35 kg/m2 or higher).

METHODS

A retrospective analysis assessing chest and spine radiographs (including Computed Tomography, CT) of patients with BMI≥35 visiting the bariatric ambulatory clinic in an academic medical center from 2013 to 2022. Patients included in the analysis were 31-50 years old. Diagnosis of DISH was made according to the Resnick criteria. The prevalence of DISH was calculated. Demographic, clinical and laboratory data were collected and compared between the DISH and non-DISH groups.

RESULTS

183 young (mean age: 40.4; 118 females, 64.2 %) obese (BMI median: 40.6; range 35-73) patients were included in the radiographic review. DISH was diagnosed in 33 patients (18.0 %; 95 % CI: 13.1-24.2 %) which was significantly higher than the expected 10 % (Z = 3.62, p<.001); another 8 patients (4.4 %; 95 % CI: 2.2-8.4 %) were considered as "near DISH" (not fulfilling yet the Resnick criteria) as it represents a pre-disease state. Patients diagnosed with DISH were significantly older than patients without DISH (t = 4.54, p<.001), as the prevalence of DISH increased by age (linear association=14.95, p<.001). There was a statistically significantly higher prevalence of hypertension (χ2 = 8.30, p<.004), smoking (χ2 = 4.69, p<.03) and OSA (χ2 = 6.16, p<.013) in the DISH group as compared to their non-DISH counterparts.

CONCLUSION

The prevalence of DISH among obese young patients was 18 %, which is much higher than in the general population. Early-onset DISH should be regarded as a musculoskeletal obesity-related complication.

Correspondence Analysis to Demonstrate the Relationship Between Musculoskeletal Pain and Body Mass Index

Background As obese people frequently experience persistent musculoskeletal pain (MSP), understanding the relationship between obesity and pain may help develop therapeutic and preventative approaches to treat discomfort from MSP. MSP can negatively impact such individuals' quality of life and their ability to perform daily tasks. Therefore, more thorough investigations are required to fully understand the connection between obesity and MSP. Aims To assess the relationship between musculoskeletal pain(MSP) and body mass index (BMI) among women in the age group of 25 to 65 years. Methods From July to December 2022, a cross-sectional study among women between the ages of 25 and 65 was carried out near the Rural Health Training Centre (RHTC) of a medical college in the Lucknow District of Uttar Pradesh, India. In total, 443 women took part in the study. BMI was computed, weight and height were recorded, and MSP at any site (i.e., neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hip/buttocks, thighs, knees, lower legs, and ankles) was noted. The data were analyzed through correspondence analysis. Results Of the 443 women that participated in the study, 224 (50.6%) had MSP, and 9.3% and 28.2% were obese or overweight, respectively. Obese and overweight women were found to be at a higher risk of upper and lower back pain. Conclusion In our study, a significant relationship between MSP and BMI was confirmed and visualized by correspondence analysis.

Osteosarcopenia and Pain: Do We Have a Way Out?

Osteosarcopenia (OSP) is a geriatric syndrome characterized by the coexistence of osteoporosis and sarcopenia and associated with an increased risk of fragility fractures, disability, and mortality. For patients with this syndrome, musculoskeletal pain represents the most significant challenge since, in addition to limiting the individual's functionality and promoting disability, it has a huge psychological burden involving anxiety, depression, and social withdrawal. Unfortunately, the molecular mechanisms involved in the development and persistence of pain in OSP have not yet been fully elucidated, although immune cells are known to play a key role in these processes. Indeed, they release several molecules that promote persistent inflammation and nociceptive stimulation, resulting in the gating of ion channels responsible for the generation and propagation of the noxious stimulus. The adoption of countermeasures to counteract the OSP progression and reduce the algic component appears to be necessary, providing patients with a better quality of life and greater adherence to treatment. In addition, the development of multimodal therapies, based on an interdisciplinary approach, appears to be crucial, combining the use of anti-osteoporotic drugs with an educational programme, regular physical activity, and proper nutrition to eliminate risk factors. Based on this evidence, we conducted a narrative review using the PubMed and Google Scholar search engines to summarize the current knowledge on the molecular mechanisms involved in the pain development in OSP and the potential countermeasures to be taken. The lack of studies addressing this topic highlights the need to conduct new research into the resolution of an ever-expanding social problem.

Epidemiology of musculoskeletal disorders among iranian adults: results from a non-communicable disease cohort study

BACKGROUND

Persistent pain and reduced mobility and dexterity are the typical characteristics of Musculoskeletal disorders (MSDs). We aimed to determine the prevalence of back and joint pain, back, and joint stiffness, arthritis, and osteoporosis among adults and their distribution according to sociodemographic characteristics and comorbidities.

METHODS

This cross-sectional study was conducted on 9,520 participants aged 35-65 years from baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west of Iran. MSDs were evaluated by the RaNCD cohort study physician using a standard questionnaire. Binary logistic regression was used to determine associations and reported by odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

The MSDs in women were significantly more than in men (59.06% vs. 40.94%, P < 0.001). Skeletal muscle mass (SMM) was significantly lower in subjects with MSDs, and waist circumference (WC) and visceral fat area (VFA) were higher than in the non-MSDs (P < 0.001). MSDs were significantly more common in urban men and women (OR = 1.33; 95% CI: 1.14-1.50 and OR = 1.59; 95% CI: 1.39-1.82, respectively). Obesity increased the odds of MSDs in women (OR = 1.57; 95% CI: 1.33-1.84), whereas there was no association between BMI and MSDs in men. Men with high socioeconomic status (SES) had lower odds of MSDs than men with weak SES (OR = 0.77; 95% CI: 0.64-0.92).

CONCLUSION

The MSDs were more prevalent among older people, women, obese people and urban dwellers. Lifestyle modification, especially weight loss may be helpful in reducing and controlling MSDs.

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.

Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy

OBJECTIVES

Aromatase inhibitors (AIs), which potently inhibit estrogen biosynthesis, are a standard treatment for hormone sensitive early-stage breast cancer. AIs have been associated with substantial joint pain and muscle stiffness (aromatase inhibitor-associated musculoskeletal syndrome). However, the link between AIs and number of clinical pain locations and pain sensitivity are less well understood. The aim of this study was to compare longitudinal changes in clinical pain and quantitative pain sensitivity between women who did or did not receive AI therapy.

METHODS

Women with early-stage breast cancer were prospectively enrolled and assessed for clinical pain in surgical and nonsurgical body areas using the Brief Pain Inventory and Breast Cancer Pain Questionnaire, and for pain sensitivity using quantitative sensory testing preoperatively and at 1 year postoperatively. Pain outcomes between participants who did and did not begin adjuvant AI therapy were compared using Wilcoxon Signed-Ranks and generalized estimating equation linear regression analyses.

RESULTS

Clinical pain and pain sensitivity were comparable between AI (n=49) and no-AI (n=106) groups preoperatively. After adjusting for body mass index, AI therapy was associated with a greater increase in the number of painful nonsurgical body sites (significant time by treatment interaction, P =0.024). Pain location was most frequent in knees (28%), lower back (26%), and ankles/feet (17%). Quantitative sensory testing revealed a significant decrease in pain sensitivity (increased pressure pain threshold) in the no-AI group over time, but not in the AI group.

CONCLUSIONS

AI therapy was associated with increased diffuse joint-related pain and greater post-treatment pain sensitivity, potentially implicating central sensitization as a contributing pain mechanism of aromatase inhibitor-associated musculoskeletal syndrome worthy of future investigation.

Obesity phenotypes related to musculoskeletal disorders; a cross-sectional study from RaNCD cohort

Background

This study was evaluated the association between obesity phenotypes and risk of lower torso musculoskeletal disorders including low back pain (LBP), low back stiffness (LBS), arthralgia, and joint stiffness in Ravansar non-communicable diseases (RaNCD) cohort study.

Methods

In this cross-sectional study, 6940 adults were examined for the presence of lower torso musculoskeletal disorders by a physician. Obesity phenotypes including metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) were defined based on the International Diabetes Federation, as well as, body mass index > 30 kg/m2. Metabolically unhealthy non-obesity (MUNO) phenotype was considered as unhealthy metabolic without obesity.

Results

The prevalence of LBP, LBS, arthralgia, and joint stiffness in MHO, MUO, and MUNO were significantly higher than in healthy participants compared to obesity phenotypes. Logistic regression showed that MHO phenotype was significantly increased with risk of LBP (OR: 1.19, CI 95%: 1.01–1.41), LBS (OR: 1.44, CI 95%: 1.12–1.86), arthralgia (OR: 1.54, CI 95%: 1.33–1.78), and joint stiffness (OR: 1.84, CI 95%: 1.35–2.52). Moreover, MUO phenotype was positively associated with risk of LBS (OR: 1.46, CI 95%: 1.09–1.94) and arthralgia (OR: 1.66, CI 95%: 1.41–1.96). In addition, MUNO phenotype was associated with a higher risk of arthralgia (OR: 1.21, CI 95%: 1.06–1.37).

Conclusion

All three phenotypes, MHO, MUO and MUNO were significantly increased the risk of arthralgia. However, MHO phenotype was significantly associated with a higher risk of all examined lower torso musculoskeletal disorders in the current study.

Chronic Pain in Musculoskeletal Diseases: Do You Know Your Enemy?

Musculoskeletal pain is a condition that characterises several diseases and represents a constantly growing issue with enormous socio-economic burdens, highlighting the importance of developing treatment algorithms appropriate to the patient’s needs and effective management strategies. Indeed, the algic condition must be assessed and treated independently of the underlying pathological process since it has an extremely negative impact on the emotional and psychic aspects of the individual, leading to isolation and depression. A full understanding of the pathophysiological mechanisms involved in nociceptive stimulation and central sensitization is an important step in improving approaches to musculoskeletal pain. In this context, the bidirectional relationship between immune cells and neurons involved in nociception could represent a key point in the understanding of these mechanisms. Therefore, we provide an updated overview of the magnitude of the musculoskeletal pain problem, in terms of prevalence and costs, and summarise the role of the most important molecular players involved in the development and maintenance of pain. Finally, based on the pathophysiological mechanisms, we propose a model, called the “musculoskeletal pain cycle”, which could be a useful tool to counteract resignation to the algic condition and provide a starting point for developing a treatment algorithm for the patient with musculoskeletal pain.

Musculoskeletal Disorders and Quality of Life in Chilean Teachers: A Cross-Sectional Study

Introduction

Teaching professionals have reported multiple conditions associated with low quality of life (QoL) perception. Various studies have also reported high prevalence of musculoskeletal disorders (MSD). In this context, there are few studies regarding the association between low QoL perception and MSD suffering in teachers.

Objective

Therefore, in this study the aim was evaluate MSD prevalence and its association with teachers' QoL perception.

Participants and Methods

A total sample of 544 Chilean teachers were included in a cross-sectional study. MSD prevalence was evaluated via the Standardized Nordic Questionnaire and QoL perception via the Short-Form 36 Health Survey Instrument. Multinomial logistic regression was applied to evaluate the association between MSD and QoL perception adjusted for gender and age.

Results

A total of 91% of teachers have had some MSD in the last 12 months, and 28.86% have had 6 or more painful regions. Females showed greater MSD prevalence than males. Teachers who reported no MSD had higher QoL scores compared to teachers with MSD. The group of teachers with the most MSD (≥p75) saw significant increases in the risk of having low scores in the physical (OR: 2.82) and mental components (OR: 2.65) of QoL. By contrast, teachers without MSD have a buffer effect for their QoL (physical OR: 0.2; mental OR: 0.44).

Conclusions

High MSD prevalence suggest that preventive and informative actions must be taken regarding these disorders to protect teachers' mental and physical health, considering the multiple risk factors to which teachers are exposed given their work conditions in Chile and worldwide.

Outcomes of Bariatric Surgery in Patients on Chronic Opioids: Can Bariatric Surgery Assist with Decreasing Long-term Opioid Utilization?

PURPOSE

The aim of our study was to assess long-term opioid use following bariatric surgery in patients on preoperative narcotics.

METHODS

We evaluated patients utilizing preoperative opioids (OP) who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2013 to 2020. Patients were propensity-matched to those without preoperative opioid use (NOP) by demographics and comorbidities. Our objectives were to compare opioid use at 1 and 3 years after surgery and evaluate perioperative outcomes.

RESULTS

A total of 806 patients, matched 1:1 were evaluated, with 82.7% being females. Mean age was 46.5 years in the OP and 45.6 years in the NOP (p = 0.0018), preoperative BMI was 45.8 in the OP and 46.1 in the NOP (p = 0.695). All patients were followed up for 1 year. In the OP, 156 (38.7%) patients were taking opioids 1 year after surgery as opposed to 27 (6.7%) in the NOP (p < 0.0001). Three years after surgery, 74 (37.5%) patients in the OP and 27 (14.4%) in the NOP were taking outpatient opioids (p < 0.0001). There was no statistically significant difference between OP and NOP groups in terms of readmissions (9.4% vs. 5.7% p = 0.06), reinterventions (3.7 vs. 1.7% p = 0.13), reoperations (3.5% vs. 1.5% p = 0.11), or emergency room visits (8.9% vs. 7.2% p = 0.44). There were no mortalities.

CONCLUSION

Most patients requiring preoperative opioids can be weaned off after bariatric surgery. Enhanced recovery pathways are key to obtaining these results. Preoperative opioid use is not associated with increased complications compared to opioid-naïve patients.

Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

BACKGROUND

Sedentary behaviour (SB; time spent sitting) is associated with musculoskeletal pain (MSP) conditions; however, no prior systematic review has examined these associations according to SB domains. We synthesised evidence on occupational and non-occupational SB and MSP conditions.

METHODS

Guided by a PRISMA protocol, eight databases (MEDLINE, CINAHL, PsycINFO, Web of Science, Scopus, Cochrane Library, SPORTDiscus, and AMED) and three grey literature sources (Google Scholar, WorldChat, and Trove) were searched (January 1, 2000, to March 17, 2021) for original quantitative studies of adults ≥ 18 years. Clinical-condition studies were excluded. Studies' risk of bias was assessed using the QualSyst checklist. For meta-analyses, random effect inverse-variance pooled effect size was estimated; otherwise, best-evidence synthesis was used for narrative review.

RESULTS

Of 178 potentially-eligible studies, 79 were included [24 general population; 55 occupational (incuding15 experimental/intervention)]; 56 studies were of high quality, with scores > 0.75. Data for 26 were meta-synthesised. For cross-sectional studies of non-occupational SB, meta-analysis showed full-day SB to be associated with low back pain [LBP - OR = 1.19(1.03 - 1.38)]. Narrative synthesis found full-day SB associations with knee pain, arthritis, and general MSP, but the evidence was insufficient on associations with neck/shoulder pain, hip pain, and upper extremities pain. Evidence of prospective associations of full-day SB with MSP conditions was insufficient. Also, there was insufficient evidence on both cross-sectional and prospective associations between leisure-time SB and MSP conditions. For occupational SB, cross-sectional studies meta-analysed indicated associations of self-reported workplace sitting with LBP [OR = 1.47(1.12 - 1.92)] and neck/shoulder pain [OR = 1.73(1.46 - 2.03)], but not with extremities pain [OR = 1.17(0.65 - 2.11)]. Best-evidence synthesis identified inconsistent findings on cross-sectional association and a probable negative prospective association of device-measured workplace sitting with LBP-intensity in tradespeople. There was cross-sectional evidence on the association of computer time with neck/shoulder pain, but insufficient evidence for LBP and general MSP. Experimental/intervention evidence indicated reduced LBP, neck/shoulder pain, and general MSP with reducing workplace sitting.

CONCLUSIONS

We found cross-sectional associations of occupational and non-occupational SB with MSP conditions, with occupational SB associations being occupation dependent, however, reverse causality bias cannot be ruled out. While prospective evidence was inconclusive, reducing workplace sitting was associated with reduced MSP conditions. Future studies should emphasise prospective analyses and examining potential interactions with chronic diseases.

PROTOCOL REGISTRATION

PROSPERO ID # CRD42020166412 (Amended to limit the scope).

The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: a cross-sectional study

Background

In the literature, there have been debates as to whether smartphone use has negative effects on physical and mental health. The present study investigated the extent to which smartphone addiction impacts on musculoskeletal pain prevalence among university students.

Methods

The questionnaire consisted of three sections demographic information, the Smartphone Addiction Scale (SAS), and the modified Nordic Musculoskeletal Questionnaire.

Results

A total of 249 participants were included in this cross-sectional study. The body parts that were reported with highest prevalence of musculoskeletal pain were the upper back (70.3%), neck (65.9%), and wrists/hands (68.7%). The SAS scores were correlated with duration of smartphone use on a typical day (P = 0.001), duration of owning a smartphone (P = 0.027), and musculoskeletal pain prevalence in the neck (P = 0.001), wrists/hands (P = 0.001), shoulders (P = 0.025), and upper back (P = 0.023). The SAS score was significantly associated with prevalence of musculoskeletal pain in the neck (odd ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.10; P = 0.002), wrists/hands (OR, 1.07; 95% CI, 0.97-1.09; P = 0.001), and upper back (OR, 1.10; 95% CI, 0.98-1.11; P = 0.033).

Conclusions

The findings indicated that the upper back, neck, and wrists/hands have a higher prevalence of musculoskeletal pain among smartphone users, particularly those with a smartphone addiction. Smartphone addiction scores were correlated with duration of smartphone use on a typical day, duration of owning smartphone, and musculoskeletal pain prevalence in the neck, wrists/hands, shoulders, and upper back.