The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Extracorporeal shock waves are high-intensity mechanical waves (500–1000 bar) of a microsecond duration with a morphology characterized by a rapid positive phase followed by a negative phase. Background: Extracorporeal shock waves have been used for pain treatment for various sub-acute and chronic musculoskeletal (MSK) problems since 2000. The aim of this article is to update information on the role of extracorporeal shock wave therapy (ESWT) in the treatment of various pathologies that cause MSK pain. Methods: Given that in the last two years, articles of interest (including systematic reviews and meta-analyses) have been published on less known indications, such as low back pain, nerve entrapments, osteoarthritis and bone vascular diseases, a literature search was conducted in PubMed, the Cochrane Database, EMBASE, CINAHL and PEDro, with the aim of developing a narrative review of the current literature on this topic. The purposes of the review were to review possible new mechanisms of action, update the level of evidence for known indications and assess possible new indications that have emerged in recent years. Results: Although extracorporeal shock waves have mechanical effects, their main mechanism of action is biological, through a phenomenon called mechanotransduction. There is solid evidence that supports their use to improve pain in many MSK pathologies, such as different tendinopathies (epicondylar, trochanteric, patellar, Achilles or calcific shoulder), plantar fasciitis, axial pain (myofascial, lumbar or coccygodynia), osteoarthritis and bone lesions (delayed union, osteonecrosis of the femoral head, Kienbock’s disease, bone marrow edema syndrome of the hip, pubis osteitis or carpal tunnel syndrome). Of the clinical indications mentioned in this review, five have a level of evidence of 1+, eight have a level of evidence of 1−, one indication has a level of evidence of 2− and two indications have a level of evidence of 3. Conclusions: The current literature shows that ESWT is a safe treatment, with hardly any adverse effects reported. Furthermore, it can be used alone or in conjunction with other physical therapies such as eccentric strengthening exercises or static stretching, which can enhance its therapeutic effect.

The Metaverse is “an integrated network of 3D virtual worlds.” It incorporates digitally created realities into the real world, involves virtual copies of existing places and changes the physical reality by superimposing digital aspects, allowing its users to interact with these elements in an immersive, real-time experience. The applications of the Metaverse are numerous, with an increasing number of experiences in the field of musculoskeletal disease management. In the field of medical training, the Metaverse can help facilitate the learning experience and help develop complex clinical skills. In clinical care, the Metaverse can help clinicians perform orthopedic surgery more accurately and safely and can improve pain management, the performance of rehabilitation techniques and the promotion of healthy lifestyles. Virtualization can also optimize aspects of healthcare information and management, increasing the effectiveness of procedures and the functioning of organizations. This optimization can be especially relevant in departments that are under significant care provider pressure. However, we must not lose sight of the fundamental challenges that still need to be solved, such as ensuring patient privacy and fairness. Several studies are underway to assess the feasibility and safety of the Metaverse.

Artificial intelligence (AI) is an iterative process by which information is captured, transformed into knowledge and processed to produce adaptive changes in the environment. AI is a broad concept, involving virtual (computing) and physical (robotics) elements. In this narrative literature review, we focus on the aspects of AI that present major opportunities for developing health care. Within a few years, AI will be part of our daily clinical practice. Although significant advances are being made, the application of AI in musculoskeletal medicine is still in its early stages compared with its implementation in other areas of medicine. AI is increasingly being employed in fields such as musculoskeletal radiology, skeletal trauma, orthopedic surgery, physical and rehabilitation medicine and sports medicine, as well as for “big data” and AI in gastrointestinal (GI) endoscopy related injuries. Among the limitations of IA are that it analyzes information based on the data it is supplied, which must therefore be well-labeled and that some algorithms such as DL uses more time, data, and computational power than other techniques. Moreover, AI currently does not solve the problem of causality that exists in medicine with observational data; information that physicians interpret within a broad clinical context. AI should therefore be integrated in a prudent and reasonable manner into the workflows of health professionals.

The enormous pressure of the increasing case numbers experienced during the COVID-19 pandemic has given rise to a variety of novel digital systems designed to provide solutions to unprecedented challenges in public health. The field of algorithmic contact tracing, in particular, an area of research that had previously received limited attention, has moved into the spotlight as a crucial factor in containing the pandemic. The use of digital tools to enable more robust and expedited contact tracing and notification, while maintaining privacy and trust in the data generated, is viewed as key to identifying chains of transmission and close contacts, and, consequently, to enabling effective case investigations. Scaling these tools has never been more critical, as global case numbers have exceeded 100 million, as many asymptomatic patients remain undetected, and as COVID-19 variants begin to emerge around the world. In this context, there is increasing attention on blockchain technology as a part of systems for enhanced digital algorithmic contact tracing and reporting. By analyzing the literature that has emerged from this trend, the common characteristics of the designs proposed become apparent. An archetypal system architecture can be derived, taking these characteristics into consideration. However, assessing the utility of this architecture using a recognized evaluation framework shows that the added benefits and features of blockchain technology do not provide significant advantages over conventional centralized systems for algorithmic contact tracing and reporting. From our study, it, therefore, seems that blockchain technology may provide a more significant benefit in other areas of public health beyond contact tracing.

Introducción: La actividad física es esencial en la población con artrosis, sin embargo, el confinamiento durante la pandemia por COVID obligó al cambio en los estilos de vida. Se llevó a cabo un estudio observacional y descriptivo con el objetivo de evaluar el ejercicio físico realizado en personas con patología osteoarticular degenerativa (POD) durante la pandemia por COVID-19. Material y métodos: Se realizó una encuesta telefónica a personas mayores de 60 años con POD atendidos previamente en el Hospital Central de la Cruz Roja, valorando el ejercicio físico durante el confinamiento por pandemia COVID-19. Se analizaron las variables (tiempo de ejercicio físico, causas si el ejercicio fue reducido, y la intensidad de dolor) y se compararon con la situación previa al confinamiento domiciliario. Resultados: Se incluyeron un total de 33 pacientes (8 hombres, 25 mujeres), con una edad media de 75,6 años. La poliartrosis fue el diagnóstico más frecuente. El 51,5% realizaban la misma cantidad de ejercicio físico, el 21.21% realizaban más y 24.2% menos que antes. Sólo el 6.1% realizaba más de una hora al día de actividad. El 36,4% tenían más dolor que previamente. Conclusiones: Aunque existe una alta adherencia a los ejercicios aprendidos en el servicio de rehabilitación, el confinamiento por covid-19 ha tenido un efecto negativo en el nivel de ejercicio realizado por los pacientes con POD. Es recomendable incentivar el ejercicio físico durante períodos de confinamiento. Introduction: Physical activity is essential in the osteoarthritis population, however, confinement during the COVID pandemic forced lifestyle changes. An observational and descriptive study was conducted to assess physical exercise in people with degenerative osteoarticular disease (DOD) during the COVID-19 pandemic. Material and methods: A telephone survey was conducted among people over 60 years of age with DOD previously treated at the Hospital Central de la Cruz Roja, assessing physical exercise during the COVID-19 pandemic confinement. The variables (time of physical exercise, causes if exercise was reduced, and pain intensity) were analysed and compared with the situation prior to home confinement. Results: A total of 33 patients (8 men, 25 women) were included, with a mean age of 75.6 years. Polyarthrosis was the most frequent diagnosis. 51.5% performed the same amount of physical exercise, 21.21% performed more and 24.2% less than before. Only 6.1% performed more than one hour a day of activity. 36.4% had more pain than previously. Conclusions: Although there is a high adherence to the exercises learned in the rehabilitation service, covid-19 confinement has had a negative effect on the level of exercise performed by POD patients. It is advisable to encourage physical exercise during periods of lockdown.