Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis

Abstract

Biopsychosocial aspects seem to influence the clinical condition of rotator cuff related shoulder pain (RCRSP). However, traditional bivariate and linear analyses may not be sufficiently robust to capture the complex relationships among these aspects. This study determined which biopsychosocial aspects would better classify individuals with acute and chronic RCRSP and described how these aspects interact to create biopsychosocial phenotypes in individuals with acute and chronic RCRSP. Individuals with acute (<six months of pain, n = 15) and chronic (≥six months of pain, n = 38) RCRSP were included. Sociodemographic data, biological data related to general clinical health status, to shoulder clinical condition and to sensory function, and psychosocial data were collected. Outcomes were compared between groups and a decision tree was used to classify the individuals with acute and chronic RCRSP into different phenotypes hierarchically organized in nodes. Only conditioned pain modulation was different between the groups. However, the tree combined six biopsychosocial aspects to identify seven distinct phenotypes in individuals with RCRSP: three phenotypes of individuals with acute, and four with chronic RCRSP. While the majority of the individuals with chronic RCRSP have no other previous painful complaint besides the shoulder pain and low efficiency of endogenous pain modulation with no signs of biomechanical related pain, individuals with acute RCRSP are more likely to have preserved endogenous pain modulation and unilateral pain with signs of kinesiophobia.

Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study

“…These findings support the inclusion of a biopsychosocial component into the treatment plan, as also described in other studies. 11 , 14 , 87 , 88 …”

Paravertebral Muscle Mechanical Properties and Spinal Range of Motion in Patients with Acute Neck or Low Back Pain: A Case-Control Study

“…Controversial results have been reported for the association between MMPs and ROM, and pain in chronic LBP patients, with some data supporting positive correlations with tone, stiffness and decrement [ 44 ], whereas others do not [ 71 ]. As occurred with the differences among the groups, it is possible that the association between pain and MMPs only appears in the chronic state, as consequence of an interaction or confluence of various predictors such as emotional, cognitive, social and physical factors [ 39 ], as described for other musculoskeletal complaints [ 58 ], but not in the acute state.…”

“…The Fear-Avoidance Beliefs Questionnaire (FABQ) and the Short Version of Tampa Scale for Kinesiophobia (TSK-11SV) were used in both groups to assess pain behavior, because fear-avoidance or kinesiophobia cover different conceptual definitions. Kinesiophobia refers to fear of movement that results from a pain vulnerability, while fear-avoidance refers to the avoidance of a potential threat with physiological, cognitive, and behavioral responses, which leads to potential fear [ 58 ]. The FABQ [ 59 , 60 ] consists of 16 phrases related to physical activity (first 5 items), which composes the physical activity subscale (FABQ-PA), and work (last 11 items), which composes the work subscale (FABQ-W).…”

Shoulder Pain in COVID-19 Survivors Following Mechanical Ventilation

“…Patients were asked about their pain perception on a scale of 0 to 10, where 0 was the absence of pain and 10 was the worst pain imaginable. Patients were also asked to differentiate between pain while lying down and while performing daily activities [ 13 ].…”