ABSTRACT
Bone repair after trauma or surgical intervention involves a tightly regulated cascade of events that starts with hemostasis and an inflammatory response, which are critical for successful healing. Nonsteroidal anti-inflammatory drugs (NSAID) are routinely prescribed for pain relief despite their potential inhibitory effect on bone repair. The goal of this study was to determine the impact of administration of the non-selective NSAID diclofenac in the inflammatory phase of bone repair in mice with or without lipopolysaccharide-induced systemic inflammation. Repair of femoral window defects was characterized using micro computed tomography imaging and histological analyses at 2 weeks postoperative. The data indicate (a) impaired bone regeneration associated with reduced osteoblast, osteoclast, and macrophage activity; (b) changes in the number, activity, and distribution of mast cells in regenerating bone; and (c) impaired angiogenesis due to a direct toxic effect of diclofenac on vascular endothelial cells. The results of this study provide strong evidence to support the conjecture that administration of NSAIDs in the first 2 weeks after orthopaedic surgery disrupts the healing cascade and exacerbates the negative effects of systemic inflammation on the repair process.
Subject(s)
Diclofenac/pharmacology , Inflammation/drug therapy , Pain/drug therapy , Wounds and Injuries/drug therapy , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Endothelial Cells/drug effects , Humans , Inflammation/chemically induced , Inflammation/pathology , Lipopolysaccharides/toxicity , Macrophages/drug effects , Male , Mice , Orthopedic Procedures/adverse effects , Osteoblasts/drug effects , Osteoclasts/drug effects , Pain/diagnostic imaging , Pain/pathology , Wounds and Injuries/complications , Wounds and Injuries/diagnostic imaging , Wounds and Injuries/pathology , X-Ray MicrotomographyABSTRACT
AIM: The study aim was to determine the prevalence of neck, shoulder, and low-back pains and to explore the factors associated with musculoskeletal pain (MSP) among medical students at university hospitals in central Saudi Arabia. METHOD: This cross-sectional study was conducted at a government institution using an online self-administered, modified version of the Standardised Nordic Questionnaire in the English language. RESULTS: A total of 469 students responded to our survey. The prevalence of MSP in at least one body site at any time, in the past week, and in the past year was 85.3%, 54.4%, and 81.9%, respectively. Factors significantly associated with MSP in at least one body site at any time were being in the clinical year (P = 0.032), history of trauma (P = 0.036), history of depressive symptoms (P < 0.001), and history of psychosomatic symptoms (P < 0.001). On multivariable regression analysis, factors associated with MSP were history of trauma (P = 0.016) and depressive (P = 0.002) or psychosomatic symptoms (P = 0.004). CONCLUSION: MSP among Saudi medical students is high, particularly among those in the clinical years and those with history of trauma and with depressive or psychosomatic symptoms. Medical institutions should be aware of this serious health issue and preventive measures are warranted.
