Study Design: Randomized controlled trial. Objective: To evaluate the effects of an exercise protocol, with and without manual therapy, on scapular kinematics, function, pain, and mechanical sensitivity in individuals with shoulder impingement syndrome. Background: Stretching and strengthening exercises have been shown to effectively decrease pain and disability in individuals with shoulder impingement syndrome. There is still conflicting evidence regarding the efficacy of adding manual therapy to an exercise therapy regimen. Methods: Forty-six patients were assigned to 1 of 2 groups, one of which received a 4-week intervention of stretching and strengthening exercises (exercise alone) and the other the same intervention, supplemented by manual therapy targeting the shoulder and cervical spine (exercise plus manual therapy). All outcomes were measured preintervention and postintervention at 4 weeks. Outcome measures were scapular kinematics in the scapular and sagittal planes during arm elevation, function as determined through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, pain as assessed with a visual analog scale, and mechanical sensitivity as assessed with pressure pain threshold. Results: Independent of the intervention group, small, clinically irrelevant changes in scapular kinematics were observed postintervention. A significant group-by-time interaction effect (P = .001) was found for scapular anterior tilt during elevation in the sagittal plane, with a 3.0° increase (95% confidence interval [CI]: −1.5°, 7.5°) relative to baseline in the exercise-plus–manual therapy group compared to a decrease of 0.3° (95% CI: −4.2°, 4.8°) in the exercise-alone group. Pain, mechanical sensitivity, and the DASH score improved similarly for both groups by the end of the intervention period. Conclusion: Adding manual therapy to an exercise protocol did not enhance improvements in scapular kinematics, function, and pain in individuals with shoulder impingement syndrome. The noted improvements in pain and function are not likely explained by changes in scapular kinematics. The study is registered at www.clinicaltrials.gov (NCT02035618). Level of Evidence: Therapy, level 1b-. J Orthop Sports Phys Ther 2015;45(12):984–997. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5939

Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water’s physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.

Chronic pain is one of the major causes of disability with a tremendous impact on an individual's quality of life and on public health. Transcutaneous vagus nerve stimulation (tVNS) is a safe therapeutic for this condition. We aimed to evaluate its effects in adults with chronic pain. A comprehensive search was performed, including randomized controlled trials published until October 2023, which assessed the effects of noninvasive tVNS. Cohen's d effect size and 95% confidence intervals (CIs) were calculated, and random-effects meta-analyses were performed. Fifteen studies were included. The results revealed a mean effect size of 0.41 (95% CI 0.17-0.66) in favor of tVNS as compared with control, although a significant heterogeneity was observed (χ² = 21.7, df = 10, P = 0.02, I ² = 53.9%). However, when compared with nonactive controls, tVNS shows a larger effect size (0.79, 95% CI 0.25-1.33), although the number of studies was small (n = 3). When analyzed separately, auricular tVNS and cervical tVNS against control, it shows a significant small to moderate effect size, similar to that of the main analysis, respectively, 0.42 (95% CI 0.08-0.76, 8 studies) and 0.36 (95% CI 0.01-0.70, 3 studies). No differences were observed in the number of migraine days for the trials on migraine. This meta-analysis indicates that tVNS shows promise as an effective intervention for managing pain intensity in chronic pain conditions. We discuss the design of future trials to confirm these preliminary results, including sample size and parameters of stimulation.

Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

Objective: To evaluate the numerical rating scale (NRS) measurement properties in women with dysmenorrhea. Methods: This was an online clinimetric study. Brazilian women aged over 18 years old with internet access to respond to online instruments were included in the study. We evaluated criterion validity (comparing women with and without dysmenorrhea), construct validity between the NRS and the bodily pain domain of the SF-36, test-retest reliability, and measurement errors (in women with dysmenorrhea). Results: Two hundred thirty-eight women with and 192 without dysmenorrhea participated in the study. For criterion validity, the area under the receiver operating characteristic curve was 0.902 (95%CI, 0.873–0.931), and a cutoff point of 3 was considered to have the best sensitivity (83%) and specificity (86%). For construct validity, the NRS showed a moderate negative correlation with the SF-36 bodily pain domain (r=-0.46; p < 0.001). For test-retest reliability and measurement errors, 105 women whose symptoms did not change between 7 and 10 days of retest, with intraclass correlation coefficient = 0.90, standard error of measurement = 0.97, and smallest detectable change = 2.76 points. Conclusions: The NRS can be considered a valid and reliable patient-reported outcome measure for assessing dysmenorrhea-related pain intensity.

Dysmenorrhea is menstrual pain of uterine origin that can be classified as primary (PD) or secondary (SD). The worldwide prevalence of dysmenorrhea has been estimated in previous systematic reviews; however, these results are often limited by the focus on specific populations, or the inclusion of studies published only in English. Therefore, we estimated the worldwide prevalence of dysmenorrhea of both PD and SD. In this systematic review, we searched 6 databases for studies reporting the prevalence of dysmenorrhea published between 2000 and 2024, without language restriction. The risk of bias of the included studies was assessed using the Joana Briggs Institute tool. Meta-analysis was conducted in Rstudio. The heterogeneity within meta-analyses was evaluated by I ² statistics. Subgroup analyses were performed by PD, SD, age group, and study setting to investigate sources of heterogeneity as well. The certainty of evidence was assessed using GRADE modified for prevalence studies. A total of 336 studies were included in this systematic review. Most of them were conducted in Asia (49.4%). The pooled worldwide prevalence of dysmenorrhea, PD, and SD were 71.3% (95% CI 68.7%-73.8%), 73% (95% CI 68%-78%), and 35% (95% CI 19%-56%), respectively. Dysmenorrhea was more prevalent in Central America (89.6%), Sri Lanka (97.7%), among adults (73.3%), and at universities (78.4%). All subgroup analyses showed high heterogeneity (I ² = 99.5%-100%) with very low certainty of evidence. This high prevalence of dysmenorrhea worldwide highlights the need for healthcare providers and public health organizations to address menstrual pain's global burden.