Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain:A retrospective case series of single center experience

BACKGROUND Osteomalacia(OM)is frequently confused with various musculoskeletal or other rheumatic diseases,especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations.AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM.METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic(spine and musculoskeletal pain clinic)primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019.We enrolled patients with hypophosphatemia,high serum bone-specific alkaline phosphatase levels,and at least one imaging finding suggestive of OM.RESULTS Eight patients with adult-onset hypophosphatemic OM were included.The back was the most common site of pain.Proximal dominant symmetric muscle weakness was observed in more than half of the patients.Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns.Six patients were diagnosed with adefovir(ADV)-induced Fanconi syndrome,and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy,respectively.After phosphorus and vitamin D supplementation and treatment for the underlying etiologies,improvements in pain,muscle strength,and gait were observed in all patients.CONCLUSION Mechanical pain characteristics,hypophosphatemia,and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM.ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

Is burnout a mediating factor between sharps injury and workrelated factors or musculoskeletal pain?

BACKGROUND Burnout,musculoskeletal pain,and sharps injuries(SIs)affect medical workers.AIM To establish a model between SIs,burnout,and the risk factors to assess the extent to which burnout affects SIs.METHODS This questionnaire was used for an observational and cross-sectional study,which was based on members at a hospital affiliated with a medical university in Taichung,Taiwan,in 2020.The valid responses constituted 68.5%(1734 of 2531).The items were drawn from the Nordic Musculoskeletal Questionnaire and Copenhagen burnout inventory and concerned work experience,occupational category,presence of chronic diseases,sleep duration,overtime work,and work schedule.Factor analysis,chi-square test,Fisher exact test,Multiple linear,logistic regression and Sobel test were conducted.The present analyses were performed using SAS Enterprise Guide 6.1 software(SAS Institute Inc.,Cary,NC,United States),and significance was set at P<0.05.RESULTS Personal and work-related burnout ranks, sex, work experience ranks, occupationalgroups, drinking in the past month, sleep duration per day, presence ofchronic diseases, overtime work ranks, and work schedule were associated withSIs. Frequent upper limb and lower limb pain (pain occurring every day or once aweek) determined to be related to SIs. High personal burnout (> Q3) and highwork-related burnout (> Q3) mediated the relationship between SIs and frequentlower limb pain. Similarly, frequent lower limb pain mediated the relationship ofSIs with high personal and high work-related burnout. High personal and highwork-related burnout mediated the relationships of SIs with overtime work andirregular shift work. The mediating model provides strong evidence of anassociation between mental health and SIs.CONCLUSIONBurnout was determined to contribute to SIs occurrence;specifically, it mediatedthe relationships of SIs with frequent musculoskeletal pain, overtime work, andirregular shift work.

Expert consensus of Chinese Association for the Study of Pain on the non-opioid analgesics for chronic musculoskeletal pain

Chronic musculoskeletal pain(CMP)is a common occurrence in clinical practice and there are a variety of options for the treatment of it.However,the pharmacological therapy is still considered to be a primary treatment.The recent years have witnessed the emergence of opioid crisis,yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly.The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics.The purpose of this consensus is to present the application of nonsteroidal antiinflammatory drugs,serotonin norepinephrine reuptake inhibitors,serotonin and norepinephrine reuptake inhibitors,muscle relaxants,ion channel drugs and topical drugs in CMP.

Stem cells for the treatment of musculoskeletal pain

Musculoskeletal-related pain is one of the most disabling health conditions affecting more than one third of the adult population worldwide. Pain from various mechanisms and origins is currently underdiagnosed and undertreated. The complexity of molecular mechanisms correlating pain and the progression of musculoskeletal diseases is not yet fully understood. Molecular biomarkers for objective evaluation and treatment follow-up are needed as a step towards targeted treatment of pain as a symptom or as a disease. Stem cell therapy is already under investigation for the treatment of different types of musculoskeletalrelated pain. Mesenchymal stem cell-based therapies are already being tested in various clinical trials that use musculoskeletal system-related pain as the primary or secondary endpoint. Genetically engineered stem cells, as well as induced pluripotent stem cells, offer promising novel perspectives for pain treatment. It is possible that a more focused approach and reassessment of therapeutic goals will contribute to the overall efficacy, as well as to the clinical acceptance of regenerative medicine therapies. This article briefly describes the principal types of musculoskeletal-related pain and reviews the stem cell-based therapies that have been specifically designed for its treatment.

Musculoskeletal Pain in Medical Students Subject to Remote Teaching during the COVID-19 Pandemic

Musculoskeletal pain is a consequence of repetitive strain, overuse, and work-related musculoskeletal disorders. In 2020, due to the new coronavirus pandemic, social isolation started, and so did online classes in a remote study strategy to replace classroom-based study routines. Thus, students adopted a different physical posture from the usual one for a longer time than usual, representing a possible risk factor for musculoskeletal pain. In this sense, this research aimed to identify the occurrence of musculoskeletal pain in medical students subject to distance learning during the COVID-19 pandemic. A cross-sectional, descriptive and exploratory study was applied through an online questionnaire, using the Google Forms application, to 154 students from the first to the fourth year of the medical course at a university in the countryside of the state of S?o Paulo. Among the participants, 99 (64.3%) were female, and 54 (35.7%) were male individuals with ages ranging from 18 and 34. In regards to the daily study time in sitting position, 83 (55.0%) reported staying more than 4 hours, 39 (25.8%) between 2 and 4 hours, and 29 (19.2%) less than 2 hours still. As for musculoskeletal pain before the pandemic;98 (63.6%) reported not feeling it, while 56 (36.4%) reported being affected by this type of pain. However, after the pandemic, 51 respondents (33.1%) continued not to feel anything, whereas 103 (66.9%) kept on having some type of musculoskeletal pain. The results obtained suggest an increase in musculoskeletal pain during the pandemic however other studies may confirm these findings.

Frequency of Musculoskeletal Pain among Surgeons in Karachi

To determine the dynamic physical strain exerted on an individual during work, an evaluation of all physical performances is necessary. For surgeons, sustaining healthy ergonomics is essential, particularly for cases requiring long standing hours. Indeed, the absence of proper ergonomics may lead to multiple musculoskeletal issues. Failure to check these problems may lead to future degenerative changes and eventually career-ending damages. Pain among surgeons is expected since they spend many hours caring for patients that they ignore their health, standing for prolonged hours. Lack of attention to work ergonomics often leads to work-related muscle pain and increased risk of problems.

The role of pain neuroscience education in the management of chronic musculoskeletal pain:a physiotherapeutic approach

Psychological,social,and environmental variables all have a role in the development,management,and treatment of chronic pain problems.Poor advice from healthcare professionals regarding movement,radiological findings,exercises,and the benefits of electrotherapeutic modalities may affect the mood and cognitive-psychological dimensions of patients with chronic musculoskeletal pain.As per the available literature evidence as of now the inclusion of pain neuroscience education followed by bio-psychosocial assessment sessions in place of standard advice-based,clinician-dominated,and passive physiotherapy care may result in better clinical outcomes in the practice.

Use of orthotics with orthotic sandals versus the sole use of orthotics for plantar fasciitis:Randomised controlled trial

BACKGROUND Plantar fasciitis(PF)affects around 10%of the population.Prefabricated orthotics with arch support has been shown to provide symptom relief in PF by decreasing the repetitive stress sustained by the plantar fascia.However,prefabricated orthotics are only effective when shoes are worn,meaning the foot may be left unsupported when it is impractical to wear shoes.Using orthotic sandals in conjunction with prefabricated orthotics may increase PF symptom relief,as they can be worn inside the home,extending the period in which the foot is supported.AIM To compare the combined use of prefabricated orthotics and orthotic sandals vs the sole use of prefabricated orthotics in the treatment of PF.METHODS 98 participants with PF were randomised into two groups.The intervention group received the Aetrex L420 Compete orthotics and the Aetrex L3000 Maui Flips(orthotic sandals),whilst the control group received the Aetrex L420 Compete orthotics only.Foot pain was assessed both by the numerical rating scale(NRS)and the pain sub-scale of the foot health status questionnaire(FHSQ).Foot functionality was measured using the function sub-scale of the FHSQ.Symptom change was measured using the global rating of change scale(GROC).RESULTS Foot pain scores measured both by NRS and FHSQ pain sub-scale showed statistically significant reductions in foot pain in both groups(P<0.05)at six months.Both groups also reported statistically significant improvements(P<0.05)in function as measured by the FHSQ function subscale and improvement of symptoms as measured by the GROC scale.Between-group analysis showed that the intervention group with the combined use of orthotics and orthotic sandals scored better on all four outcome measures as compared to the control group with the sole use of orthotics.However,the between-group analysis only reached statistical significance on the NRS pain score(P<0.05).CONCLUSION Combined use of prefabricated orthotics and orthotic sandals provides a greater decrease in foot pain and improvement in foot function in PF compared to using prefabricated orthotics alone.

The Effects of Anma (Traditional Japanese Massage)—Randomised Trial

Background and Objective: Anma is a traditional Japanese bodywork therapy that has not been widely known and used in the West. There have been only a few Anma studies published in English journals. To study the effect of Anma (traditional Japanese massage) among participants who have neck and shoulder stiffness symptoms (so-called Katakori, in Japanese). Methods: The study participants consisted of seventy-seven (Study 1), thirteen (Study 2), and twenty (Study 3) adults with “Katakori” symptoms. The research design is as follows: (Study1) Randomized, Parallel-Group, Controlled Trial. (Study 2) Crossover Clinical Trial. (Study 3) Randomized, Parallel-Group, Controlled Trial. And we conducted Anma treatment for 45 minutes (Treatment) or rest in lying position for 45 minutes (Control). Results: In study 1, the symptom of “Katakori” was relieved after Anma treatment in Anma group (p d: 2.2). There was a significant interaction between the Anma group and the control group (p < 0.001). In study 2, MBV significantly increased following Anma treatment. There was a significant interaction between the Anma group and the control group (p = 0.022). In study 3, the symptom of “Katakori” was relieved after Anma treatment in the treatment group. There were no significant interactions between the groups in VAS and MBV values. Discussion and Conclusions: The study demonstrated that Anma therapy decreases “Katakori” symptoms while increasing MBV in the shoulder region.

Left-Handed Students and Clinical Practice in Dentistry: Adaptations, Difficulties and Realities Experienced in the Academic Environment

Objectives: To verify the existence of difficulties throughout the course of dentistry clinical practices, identify musculoskeletal pain, and evaluate frequency and intensity of pain/discomfort (if existent) in different regions of the body, experienced by left- handed students in comparison to right-handed students of the odontology courses of the state of Rio Grande do Norte (Northeast Brazil). Methods: A general questionnaire was applied to identify left-handed students in a population of 750 students, enrolled in clinical courses. An adaptation of the Grad-Corllet Diagram and a specific questionnaire on clinical practices were applied to the selected students. Descriptive statistics was utilized to analyze data of the specific questionnaire, and Mann-Whitney statistics, chi-square or Fisher’s Exact tests (with a 5% significance level) were utilized for the Grad-Corllet Diagram, searching for an association be- tween discomfort/pain in different body regions and manual laterality. Results: All students presented higher percentage of pain in the lumbar and neck/cervical re- gions. However, left-handed students presented higher values, with statistical signifi- cance levels of p = 0.041 for lower back, p = 0.002 for neck and p = 0.003 for cervical region. Conclusions: The majority of left-handed students classified “moderate” the difficulty of working with equipment designed for right-handers. There was high frequency of musculoskeletal pain/discomfort, with relevant statistical results for left- handed students regarding intensity. It is suggested that the participating institutions evaluate the adoption of inclusion politics, re-adapt the infrastructure to include equipment designed for left-handers, and finally provide adequate work conditions for all students.