Background: The close relationship between pain and mental health problems is well-known, and psychological intervention can provide an effective alternative to medication-based pain relief. However, previous studies on the connection between pain and psychological problems, the findings thus far have been inconclusive, limiting the potential for translating psychological interventions into clinical practice. To complement the gap, this study utilized genetic data and Mendelian randomization (MR) to examine the potential relationship between pain in different parts and common mental disorders. Methods: Based on the instrumental variables selected from the Genome-wide association study summary statistics of localized pain and mental disorders, we conducted bidirectional two-sample MR analyses to infer bidirectional causal associations between pain and mental disorders. The inverse-variance weighted MR method and MR-Egger were used as the primary statistical method according to the horizontal pleiotropy and heterogeneity level. We reported the odds ratio to infer the causal effect between pain and mental disorders. F statistic was calculated to measure the statistical efficacy of the analyses. Results: Insomnia is causally related to the genetic susceptibility of multisite pain including head (OR = 1.09, 95% CI: 1.06–1.12), neck/shoulder (OR = 1.12, 95% CI: 1.07–1.16), back (OR = 1.12, 95% CI: 1.07–1.18) and hip (OR = 1.08, 95% CI: 1.05–1.10). Reversely, headache (OR = 1.14, 95% CI: 1.05–1.24), neck/shoulder pain (OR = 1.95, 95% CI: 1.03–3.68), back pain (OR = 1.40, 95% CI: 1.22–1.60), and hip pain (OR = 2.29, 95% CI: 1.18–4.45) promote the genetic liability of insomnia. Depression is strongly associated with the predisposition of multisite pain including headache (OR = 1.28, 95% CI: 1.08–1.52), neck/shoulder pain (OR = 1.32, 95% CI: 1.16–1.50), back pain (OR = 1.35, 95% CI: 1.10–1.66) and stomach/abdominal pain (OR = 1.14, 95% CI: 1.05–1.25), while headache (OR = 1.06, 95% CI: 1.03–1.08), neck/shoulder (OR = 1.09, 95% CI: 1.01–1.17), back (OR = 1.08, 95% CI: 1.03–1.14), and stomach/abdominal pain (OR = 1.19, 95% CI: 1.11–1.26) are predisposing factors for depression. Additionally, insomnia is associated with the predisposition of facial, stomach/abdominal, and knee pain, anxiety was associated with the predisposition of neck/shoulder and back pain, while the susceptibilities of hip and facial pain are influenced by depression, but these associations were unidirectional. Conclusions: Our results enhance the understanding of the complex interplay between pain and mental health and highlight the importance of a holistic approach to pain management that addresses both physical and psychological factors.

Importance: Both tuina therapy and yijinjing exercise were beneficial to patients with nonspecific chronic neck pain, but the evidence for this combination is limited.Objective: To investigate the effectiveness of tuina therapy combined with yijinjing exercise compared with tuina therapy alone for patients with nonspecific chronic neck pain.Design, Setting, and Participants: A 12-week, open-label, analyst-blinded randomized clinical trial (8-week intervention plus 4-week observational follow-up) was conducted from September 7, 2020, to October 25, 2021. A total of 102 participants with nonspecific chronic neck pain were recruited, and data were analyzed from December 10, 2021, to March 26, 2022.Interventions: Participants in the tuina group or tuina combined with yijinjing group received 3 sessions of tuina therapy per week for 8 weeks, for a total of 24 sessions. Participants in the tuina combined with yijinjing group practiced yijinjing 3 times a week for 8 weeks, including an instructor-guided exercise at the hospital and 2 self-practice exercises at home.Main Outcomes and Measures: The primary outcome was change in visual analog scale (VAS) score from baseline to week 8. Secondary outcomes included Neck Disability Index scores, Self-rating Anxiety Scale scores, tissue hardness, and active range of motion.Results: This randomized clinical trial recruited 102 patients (mean [SD] age, 36.5 [4.9] years; 69 [67.6%] female) who were randomized to 2 groups. All 102 patients (100%) completed all the outcome measurements. The mean difference in VAS scores from baseline at week 8 for the tuina combined with yijinjing group was −5.4 (95% CI, −5.8 to −5.1). At week 8, the difference in VAS score was −1.2 (95% CI, −1.6 to −0.8; P < .001) between the tuina group and the tuina combined with yijinjing group. The effectiveness of tuina combined with yijinjing in treating nonspecific chronic neck pain remained at the 12-week follow-up.Conclusions and Relevance: In this randomized clinical trial, for patients with nonspecific chronic neck pain, tuina combined with yijinjing was more effective than tuina therapy alone in terms of pain, functional recovery, and anxiety at week 8, and effectiveness remained at week 12. A combination of tuina and yijinjing should be considered in the management of nonspecific chronic neck pain.Trial Registration: Chinese Clinical Trial Registry: ChiCTR2000036805

Although Tai Ji Quan has been shown to relieve pain and improve functional mobility in people with knee osteoarthritis (OA), little is known about its potential benefits on gait characteristics among older Chinese women who have a high prevalence of both radiographic and symptomatic knee OA. This study aims to assess the efficacy of a tailored Tai Ji Quan intervention on gait kinematics for older Chinese women with knee OA. A randomized controlled trial involving 46 older women in Shanghai, China, with clinically diagnosed knee OA. Randomized (1:1) participants received either a 60 min Tai Ji Quan session (n = 23) 3 times weekly or a 60 min bi-weekly educational session (n = 23) for 24 weeks. Primary outcomes were changes in gait kinematic measures from baseline to 24 weeks. Secondary outcomes included changes in scores on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short Physical Performance Battery (SPPB). After 24 weeks the Tai Ji Quan group demonstrated better performance in gait velocity (mean difference, 8.40 cm/s, p = 0.01), step length (mean difference, 3.52 cm, p = 0.004), initial contact angle (mean difference, 2.19°, p = 0.01), and maximal angle (mean difference, 2.61°, p = 0.003) of flexed knees during stance phase compared to the control group. In addition, the Tai Ji Quan group showed significant improvement in WOMAC scores (p < 0.01) (mean difference, -4.22 points in pain, p = 0.002; -2.41 points in stiffness, p < 0.001; -11.04 points in physical function, p = 0.006) and SPPB scores (mean difference, 1.22 points, p < 0.001). Among older Chinese women with knee OA, a tailored Tai Ji Quan intervention improved gait outcomes. The intervention also improved overall function as indexed by the WOMAC and SPPB. These results support the use of Tai Ji Quan for older Chinese adults with knee OA to both improve their functional mobility and reduce pain symptomatology.

Objective.To evaluate the effectiveness of massage therapy (MT) for neck and shoulder pain.Methods.Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs) of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale. The meta-analyses of MT for neck and shoulder pain were performed.Results.Twelve high-quality studies were included. In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57;P<0.00001) and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45;P=0.002) versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49;P=0.003). But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, −0.38 to 0.63;P=0.63) or shoulder pain (SMD, 0.88; 95% CI, −0.74 to 2.51;P=0.29) than active therapies. In addition, functional status of the shoulder was not significantly affected by MT.Conclusion.MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

Background: Local neuroinflammation secondary to spinal nerve compression in lumbar disk herniation (LDH) is a key driver contributing to neuropathic pain. Manual therapy (MT), a widely used nonsurgical therapy, can relieve LDH-mediated pain by reducing inflammation. MT has attracted extensive attention; however, its mechanism remains poorly understood. MicroRNAs (miRNAs) are important regulators of pain signaling transduction, but are rarely reported in the chronic compression of dorsal root ganglia (CCD) model, and further investigation is needed to decipher whether they mediate anti-inflammatory and analgesic effects of MT.Methods: We used a combination of in vivo behavioral and molecular techniques to study MT intervention mechanisms. Neuropathic pain was induced in a CCD rat model and MT intervention was performed according to standard procedures. Enzyme-linked immunosorbent assay (ELISA) was used to detect inflammatory cytokine levels in dorsal root ganglia (DRG). Small RNA sequencing, immunofluorescence, Western blot, and qRT-PCR were performed to screen miRNAs and their target genes and determine core factors in the pathway possibly regulated by miRNA-mediated target gene in DRG of MT-treated CCD rats.Results: Compared with naive rats, small RNA sequencing detected 22 differentially expressed miRNAs in DRG of CCD rats, and compared with CCD rats, MT-treated rats presented 19 differentially expressed miRNAs, which were functionally associated with nerve injury and inflammation. Among these, miR-547-3p was screened as a key miRNA mediating neuroinflammation and participating in neuropathic pain. We confirmed in vitro that its function is achieved by directly regulating its target gene Map4k4. Intrathecal injection of miR-547-3p agomir or MT intervention significantly reduced Map4k4 expression and the expression and phosphorylation of IκBα and p65 in the NF-κB pathway, thus reducing the inflammatory cytokine levels and exerting an analgesic effect, whereas intrathecal injection of miR-547-3p antagomir led to opposite effects.Conclusions: In rats, CCD-induced neuropathic pain leads to variation in miRNA expression in DRG, and MT can intervene the transcription and translation of inflammation-related genes through miRNAs to improve neuroinflammation and alleviate neuropathic pain. MiR-547-3p may be a key target of MT for anti-inflammatory and analgesia effects, which is achieved by mediating the Map4k4/NF-κB pathway to regulate downstream inflammatory cytokines.

Background: Type 2 diabetes is considered one of the most psychologically demanding chronic conditions. Patients suffering from this disease often have poor psychological well-being due to emotional stress. Baduanjin exercises, a traditional Chinese mind-body exercise, are used in the management of type 2 diabetes, especially for mental health. However, the effect of Baduanjin exercises on psychological well-being of patients with type 2 diabetes maintains controversial. Therefore, this systematic review was conducted to evaluate the effects on psychological well-being of Baduanjin exercises for type 2 diabetes.Methods: Six electronic databases were searched from their inception to March 2022 for randomized controlled trials of Baduanjin exercises for type 2 diabetes. Two reviewers independently extracted data and assessed methodological quality based on PEDro scale. The subgroup analysis was conducted based on different control interventions. The Cochran Q statistic and I² were applied to assess the heterogeneity.Results: Twenty-seven studies between 2005 and 2019 were included in our review. Most of them exceeded the cutoff score 6 based on the PEDro scale. In psychological well-being, the aggregated results indicated that Baduanjin exercises showed positive effects in psychological well-being (SMD, 0.96; 95% CI, 0.57 to 1.36; p < 0.00001), depression (SMD, 1.03; 95% CI, 0.08 to 1.97; p = 0.03), anxiety (SMD, 0.88; 95% CI, 0.30 to 1.46; p = 0.003), and mental health (SMD, 0.72; 95% CI, 0.42 to 1.02; p < 0.00001). In glycemic control, Baduanjin exercises showed better improvements in FBG (SMD, 0.53; 95% CI, 0.34 to 0.72; p < 0.00001), HbA1c (SMD, 0.58; 95% CI, 0.41 to 0.75; p < 0.00001), and 2-hPBG (SMD, 0.56; 95% CI, 0.08 to 1.03; p = 0.02) compared with usual care/education. However, Baduanjin exercises only showed better improvements in HbA1c when compared with other exercises.Conclusions: The traditional Chinese mind-body exercise-Baduanjin is a beneficial comprehensive therapy for type 2 diabetes, especially in promoting psychological well-being.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=110034.