Influence of psychological factors on the prognosis of chronic shoulder pain: protocol for a prospective cohort study

Abstract

IntroductionShoulder pain is a highly prevalent condition. Psychological factors could play an essential role in the prognosis of chronic shoulder pain (CSP). The aims of the study will be to analyse the level of association between psychological factors and pain-disability at baseline and prospectively to assess their prognostic role; to evaluate the association of pain catastrophising and kinesiophobia at baseline and prospectively in the relationship between pain intensity and disability, or between self-efficacy and disability in patients with CSP; to explore the association of self-efficacy at baseline and prospectively in the relationship between pain intensity and disability, in comparison with kinesiophobia and pain catastrophising.Methods and analysisThe study is a longitudinal, prospective cohort study with a 12-month follow-up. It will be conducted in 4 primary-care centres and one hospital of the province of Malaga, Spain. 307 participants aged between 18 and 70 years suffering from CSP (3 months or more) will be included. Primary outcomes will include pain, disability and self-efficacy, whereas kinesiophobia, pain-related fear, pain catastrophising, anxiety, depression, patient expectations of recovery, age, gender, duration/intensity of symptoms, educational level and other factors will be predictive measures. Follow-up: baseline, 3, 6 and 12 months.Ethics and disseminationThe local ethics committee (The Costa del Sol Ethics Committee, Malaga, 28042016) has approved this protocol. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals.Trial registration numberNCT02738372; pre-results

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

“…Other biopsychosocial aspects were previously found to be altered in people with shoulder complaints, such as distorted sensory information, health-related quality of life, catastrophizing, worrying, somatization, anxiety and depression [ 7 , 8 , 9 , 19 , 28 , 29 , 36 , 106 , 112 ]. Although the predictability of some of them was related to shoulder prognosis, they were not different between individuals with acute and chronic RCRSP and none of them were selected by the tree as classifiers of these conditions.…”

“…Potential individuals were excluded for the following: body mass index above 28 kg/m 2 [ 40 ], history of fracture or surgery at the shoulder or cervicothoracic spine [ 29 ], signs of adhesive capsulitis (loss of more than 50% of passive range of motion in any direction) [ 2 , 41 ] or instability [ 42 ], cervical radiculopathy radiating to shoulder [ 2 , 43 ], physical therapy treatment or corticosteroid injection within 6 months prior to evaluation, history of cancer, neurologic, systemic, rheumatic or vascular disorder [ 2 , 44 , 45 ], cognitive impairments [ 45 ], use of psychiatric medication [ 46 , 47 ] or previous diagnosis associated with central sensitivity syndromes, as determined by part B of the Central Sensitization Inventory [ 48 ]. In central sensitivity syndromes, no specific organic cause can be found, and central sensitization is the root cause of the disorders [ 48 ].…”

“…Negative emotional and behavioral aspects, such as distress, depression, anxiety, pain catastrophizing, kinesiophobia, fear-avoidance beliefs or low self-efficacy, may influence central pain modulation [ 18 ] and contribute to, or even predict, persistent shoulder complaints [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. However, it is not clear yet which negative or positive social and psychological aspects are more prevalent or lead to a better prediction of persistent complaints in individuals with RCRSP [ 28 , 33 , 34 , 35 , 36 ].…”

“…Based on the above, findings about the biopsychosocial aspects in individuals with RCRSP are not consistent among studies. Some aspects seem to influence the chronicity of the condition but may not explain the whole clinical picture of the individuals [ 8 , 9 , 10 , 18 , 26 , 27 , 28 , 29 , 30 , 32 ]. The poor predictive capability observed in different biopsychosocial aspects may be due to the multifactorial nature of RCRSP.…”

Relationships of Pain Intensity, Kinesiophobia and Quality of Life in Chronic Subacromial Pain Syndrome

“…The relationships between kinesophobia and other factors such as demographic characteristics, pain intensity, complaint duration, quality of life might be helpful for further interpretation and dealing with the fear and the musculoskeletal pain. Calderon et al 26 have stated that level of education may be a decisive factor in shoulder pain. Dunn et al 27 showed that pain was not related to rotator cuff tear severity but could be correlated with co-morbidities such as lower education level, and ethnicity.…”