Sensory processing and central pain modulation in patients with chronic shoulder pain: A case‐control study

Abstract

Chronicity and recurrence in musculoskeletal shoulder pain are highly prevalent and can possibly be attributed to the concept of central sensitization. Available studies suggest a role for central sensitization in explaining chronic shoulder pain, but so far a comprehensive quantitative sensory testing (QST) protocol has not been used. The aim of this study was to gain knowledge on sensory processing and central pain modulatory mechanisms in patients suffering from chronic shoulder pain using such a QST protocol. Fifty study participants, including chronic shoulder pain patients and healthy controls, underwent a standardized, comprehensive psychophysical testing procedure. A static adapted QST protocol (including pressure algometry, vibration and mechanical detection) was applied. Thereafter, all subjects underwent dynamic measures of temporal summation and conditioned pain modulation. Questionnaires assessing psychosocial factors were completed by each subject. No significant differences (P >= .05) were found between patients and controls based on pressure algometry, vibration detection, mechanical detection, temporal summation, and conditioned pain modulation. Moderate positive correlations (r = .5) were found between pressure pain thresholds (PPTs) and the amount of sports participation. Weak-to-moderate negative correlations (r = -.3 à -.5) were found between PPTs and psychosocial factors such as pain catastrophizing. Based on these findings, we can conclude that central sensitization is no characteristic feature in chronic musculo-skeletal shoulder pain but can be present in individual cases.

Clinical Outcomes and Central Pain Mechanisms are Improved After Upper Trapezius Eccentric Training in Female Computer Users With Chronic Neck/Shoulder Pain

“…In a similar study protocol and in line with the present findings, no differences in CPM were found between computer users with or without a low level of musculoskeletal pain 8 . The same findings have been reported in chronic isolated neck 83 , or shoulder pain 88 . The current study found that CPM was negatively correlated with self-reported disability, suggesting that ongoing pain intensity and disability may influence central pain processing, as observed in computer users with chronic pain 8 , and in painful knee osteoarthritis 11 .…”

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

“…Preserved endogenous pain modulation was also found in two less frequent phenotypes among individuals with chronic RCRSP, those with no other pain intensity higher than seven points associated with bilateral RCRSP (phenotype CSP-3) or with unilateral RCRSP without kinesiophobia (phenotype CSP-4). Although apparently controversial, current evidence in chronic pain suggests that a robust endogenous pain inhibition is uncommon but possible [97][98][99][100]108] since low CPM efficiency is not a uniform aspect in individuals with chronic shoulder pain [21,22]. The presence of bilateral symptoms indicates that these individuals might have poor prognosis over time [7], but low levels of kinesiophobia are related to better shoulder prognosis [36], which together may contribute to the robustness of the endogenous pain modulation.…”

Relationships Between Psychological, Sleep, and Physical Activity Measures and Somatosensory Function in People With Peripheral Joint Pain: A Systematic Review and Meta‐Analysis

“…Knee pain (11 studies; n = 1,146 participants) was the most commonly investigated among the included studies, and shoulder pain (5 studies; n = 361 participants) was the second most commonly investigated. The majority of studies ( n = 13) used cross‐sectional designs, except for 4 studies 50–53 …”

“…The most frequently investigated psychological variables in the included studies were depression (59%), pain catastrophizing (47%), anxiety (23%), and pain vigilance and positive and negative affect (17%). Sleep was measured in 2 studies, and both had participants with knee pain, 28,54 while physical activity level was examined in 3 studies among individuals with knee and shoulder pain 22,28,52 . The other investigated factors include illness perceptions, 22 optimism, 55 self‐efficacy, 56 coping, reactivity, anger, 57 fear of pain, 20 and emotional stress 53 .…”