A proposed mechanism of chronic pain is dysregulation between the main inhibitory (GABA) and excitatory (glutamate) neurometabolites of the central nervous system. The level of these neurometabolites appears to differ in individual studies of people with pain compared to pain-free controls across different pain conditions. However, this has yet to be systematically investigated. To establish whether GABA, glutamate, glutamine and Glx levels differ across pain conditions when compared to pain-free controls. Five databases were searched. Studies were included if they investigated: 1) A pain condition compared to control. 2) Reported GABA, glutamate, glutamine or glutamate/glutamine level. 3) Used 1H-Magnetic Resonance Spectroscopy (Prospero Project ID CRD42018092170). Data extracted included neurometabolite level, pain diagnosis, and spectroscopy parameters. Meta-analyses were conducted to establish the difference in neurometabolite level between participants with pain and pain-free controls for different pain conditions. The MRS-Q was developed from existing clinical consensus to allow for the assessment of quality in the included studies. Thirty-five studies were included investigating combinations of migraine (n = 11), musculoskeletal pain (n = 8), chronic pain syndromes (n = 9) and miscellaneous pain (n = 10). Higher GABA levels were found in participants with migraine compared to controls (Hedge's G 0.499, 95%CI: 0.2 to 0.798). In contrast, GABA levels in musculoskeletal pain conditions (Hedge's G -0.189, 95%CI: 0.530 to 0.153) and chronic pain syndromes (Hedge's G 0.077, 95%CI: 1.612 to 1.459) did not differ from controls. Results for other brain neurometabolites revealed significantly higher levels for glutamate in participants with migraine and Glx in chronic pain syndromes compared to controls. These results support the theory that underlying neurometabolite levels may be unique in different pain conditions and therefore representative of biomarkers for specific pain conditions.

Government is key to promoting physical activity at the population level through policy. The government was one of the physical activity indicators graded for the 2022 Philippine Physical Activity Report Card based on ten physical activity-related policies. This study aimed to evaluate the scope of the policies and to update these policies. Philippine government databases were searched for policies using physical activity-related key terms. Policies found were evaluated using the Wales Active Healthy Kids scoring rubric. The overall grade was converted to a letter grade based on the Global Matrix 4.0 grading system. The authors analyzed the policies’ scope and implications to practice and policy. Seven additional policies were found. Considering all 17 policies, the government indicator grade is now A- from the preliminary grade of B. The scope covers promoting physical activity mainly through sports participation and active transport among students, student-athletes, persons with disabilities, and the general population in school and community settings. The gap between government and overall physical activity (F) scores suggests the need for a comprehensive physical activity plan promoting various forms of physical activity and reducing sedentary behavior among all Filipino youth and across various settings. Crucial to achieving change is a well-coordinated, whole-of-systems approach to promoting active healthy lifestyles.