An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain

Abstract

BackgroundNeck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance).MethodsNineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study.ResultsNSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst.ConclusionThese results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.

Exploring the Causes of Neck Pain and Disability as Perceived by Those Who Experience the Condition: A Mixed-Methods Study

“…It has been suggested the reduced PPT at a distal site is indicative of dysfunction in the central nociceptive processing pathways, more commonly seen in those with neck pain of traumatic etiology [40]. Recent evidence has also emerged to suggest that pain threshold, most notably thermal pain, has an association with psychological states including depression [41,42]. This raises the potential for a shared mechanism between depressive mood, pain, and nociceptive processing, and a potential mechanistic pathway for our findings.…”

Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial

“…We did not take into account patient factors such as fear avoidance behaviors, anxiety and depression, and patient satisfaction, which may have influenced the shoulder outcome measures. [37][38][39][40] Previous studies suggested that verbal and surgical interventions resulted in decreased fear avoidance behaviors 41,42 and improved patient satisfaction 43 without improvements in functional outcomes. A second limitation was that there was a statistically significant difference in symptom duration between the groups at baseline.…”

Cardiovascular responses to an acute psychological stressor are associated with the cortisol awakening response in individuals with chronic neck pain

“…Additionally, psychological distress is a prevalent comorbid condition for many chronic pain disorders, including neck pain (Nieto 2011, Sjors 2011). Psychological factors may not only contribute to the initial development of chronic pain, but may also facilitate its chronicity given that maladaptive responses to psychological stressors contribute to a poor prognosis for recovery from pain (Linton 2000).…”