Psychophysical and Patient Factors as Determinants of Pain, Function and Health Status in Shoulder Disorders

Abstract

Objective:To estimate the extent to which psychophysical quantitative sensory test (QST) and patient factors (gender, age and comorbidity) predict pain, function and health status in people with shoulder disorders. To determine if there are gender differences for QST measures in current perception threshold (CPT), vibration threshold (VT) and pressure pain (PP) threshold and tolerance.Design:A cross-sectional study design.Setting:MacHAND Clinical Research Lab at McMaster University.Subjects:34 surgical and 10 nonsurgical participants with shoulder pain were recruited.Method:Participants completed the following patient reported outcomes: pain (Numeric Pain Rating, Pain Catastrophizing Scale, Shoulder Pain and Disability Index) and health status (Short Form-12). Participants completed QST at 4 standardized locations and then an upper extremity performance-based endurance test (FIT-HaNSA). Pearson r’s were computed to determine the relationships between QST variables and patient factors with either pain, function or health status. Eight regression models were built to analysis QST’s and patient factors separately as predictors of either pain, function or health status. An independent sample t-test was done to evaluate the gender effect on QST.Results:Greater PP threshold and PP tolerance was significantly correlated with higher shoulder functional performance on the FIT-HANSA (r =0.31-0.44) and lower self-reported shoulder disability (r = -0.32 to -0.36). Higher comorbidity was consistently correlated (r =0.31-0.46) with more pain, and less function and health status. Older age was correlated to more pain intensity and less function (r =0.31-0.57). In multivariate models, patient factors contributed significantly to pain, function or health status models (r2 =0.19-0.36); whereas QST did not. QST was significantly different between males and females [in PP threshold (3.9 vs. 6.2, p < .001) and PP tolerance (7.6 vs. 2.6, p < .001) and CPT (1.6 vs. 2.3, p =.02)].Conclusion:Psychophysical dimensions and patient factors (gender, age and comorbidity) affect self-reported and performance-based outcome measures in people with shoulder disorders.

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

“…The experimenter was cued through audio signals to deliver the contacts at precise timings during the experiment. While quantitative sensory testing for pain thresholds has limitations as pain is very subjective [ 12 ] and can vary with the modality of pain applied [ 13 ], this particular session aimed to establish a temperature for each individual that would elicit a consistent response of moderate pain which was used in the subsequent fMRI portion of the study.…”

Evaluating the novel added value of neurophysiological pain sensitivity within the fear‐avoidance model of pain

“…Consistent with previous research (Hergenroeder, Wert, Hile, Studenski, & Brach, ; Thumboo, Chew, & Lewin‐Koh, ; Uddin et al, ; Uddin, Macdermid et al, ), covariates were designed to capture socio‐demographic attributes commonly associated with pain and physical function and included gender, ethnicity, number of comorbidities and body mass index (BMI). Gender (coded as man/woman), ethnicity (coded as Caucasian/non‐Caucasian) and comorbidities were assessed by asking participants to self‐identify additional health conditions from a list of 24 conditions.…”

“…QST is an indirect, psychophysical proxy of neurophysiological sensitization and consists of evaluating subjective responses to standardized sensory stimuli (e.g., blunt pressure and pinprick). Previous work has shown a partially overlapping relationship between QST measures and FAM‐related psychological factors (Finan et al, ; Hübscher et al, ; Mason, O'Neill, Lunt, Jones, & McBeth, ; Uddin, MacDermid, Moro, Galea, & Gross, ; Wallin, Liedberg, Börsbo, & Gerdle, ; Wideman et al, ). Different QST measures of pain sensitivity have also been linked to neurophysiological indicators of nervous system sensitization and clinical pain‐related outcomes (Binderup, Arendt‐Nielsen, & Madeleine, ; Bishop, Horn, & George, ; Graven‐Nielsen & Arendt‐Nielsen, ; Lim et al, ; Neziri et al, ; Staud, Robinson, & Price, ; Tampin, Slater, Hall, Lee, & Kathryn, ; Uddin & MacDermid, ; Uddin, MacDermid, Galea, Gross, & Pierrynowski, ).…”

A Cumulative Impact of Psychological and Sensitization Risk Factors on Pain‐Related Outcomes

“…Different psychophysical measures of pain sensitivity have been linked to neurophysiological indicators of sensitization risk factors for pain‐related outcomes 18,24–31 . Specifically, pressure pain threshold (PPT) is a reliable, valid, and clinically convenient psychophysical measure for chronic musculoskeletal pain assessment and commonly regarded as a generalized measure of nervous system sensitivity aligned with pain‐related outcomes 24,28,32–38 …”