Psychosocial factors, disability and quality of life in chronic shoulder pain patients with central sensitization
Chronic shoulder pain is a complex and multidimensional phenomenon with multiple causative factors involved in its per petuation. Alteration of central nervous system processing along with the central sensitization is a predominant feature in chronic pain. Reduction in physical function has an impact on the psycho logical well-being of an individual. The aim of the study was to compare pain, kinesiophobia, catastrophizing, disability and qual ity of life in chronic shoulder pain patients with and without cen tral sensitization. Eighty chronic unilateral shoulder pain patients in the age group of 40 to 60 years were recruited. Of them, 38 were chronic shoulder pain with central sensitization and 42 with out central sensitization, classified on the basis of central sensiti zation inventory. Pain catastrophizing was measured using the pain catastrophizing scale, kinesiophobia using Tampa scale of kinesiophobia, disability using Shoulder pain and disability index and quality of life using 36-Item Short Form Health Survey ques tionnaire was evaluated in both the groups. Increased pain catas trophizing (p=0.000), kinesiophobia (p=0.000) and disability (p=0.000) was observed in centrally sensitized chronic shoulder pain patients. Also, physical component summary (p=0.000) and mental component summary (p=0.000) of SF-36 quality of life were reduced in chronic shoulder pain with central sensitization as compared to without central sensitization. Hence, these compo nents should be included during assessment which will provide a holistic and multimodal approach towards the understanding, planning and management of chronic shoulder pain patients.
1. Arendt-Nielsen, L., Fernández-de-Las-Peñas, C., & Graven-Nielsen, T. (2011). Basic aspects of musculoskeletal pain: from acute to chronic pain. The Journal of Manual and Manipualtive Therapy, 19(4), 186-193.
2. Borstad, J. & Woeste, C. (2015). The role of sensitization in musculoskeletal shoulder pain. Brazilian Journal of Physical Therapy, 19(4), 251–257.
3. Brazier, J.E., Harper, R., Jones, N.M., O’Cathain, A., Thomas, K.J., Usherwood, T., & Westlake, L. (1992). Validating the SF-36 health survey questionnaire: New outcome measure for primary care. The BMJ, 305(6846), 160–164.
4. Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2018). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. British Journal of Sports Medicine, 52(4), 269-275.
5. Diatchenko, L., Fillingim, R.B., Smith, S.B., & Maixner, W. (2013). The phenotypic and genetic signatures of common musculoskeletal pain conditions. Nature Reviews. Rheumatology, 9(6), 340–350.
6. DeSantana, J.M., & Sluka, K.A. (2008). Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain. Current Pain and Headache Reports, 12(5), 338–343.
7. Fillingim, R.B., Loeser, J.D., Baron, R., & Edwards, R.R. (2016). Assessment of chronic pain: domains, methods, and mechanisms. The Journal of Pain, 17(9 Suppl): T10-T20.
8. Gatchel, R.J., Peng, Y.B., Peters, M.L., Fuchs, P.N., & Turk, D.C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133(4), 581–624.
9. Kori, S., Miller, R., Todd, D. (1990). Kinesiophobia: a new view of chronic pain behavior. Pain Management, 3(1), 35–43.
10. Kromer, T.O., Sieben, J.M., de Bie, R.A., & Bastiaenen, C.H. (2014). Influence of fear avoidance beliefs on disability in patients with subacromial shoulder pain in primary care: a secondary analysis. Physical Therapy, 94(12), 1775–84.
11. Latremoliere, A., & Woolf, C.J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), 895-926.
12. Leeuw, M., Goossens, M.E., Linton, S.J., Crombez, G., Boersma, K., & Vlaeyen, J.W. (2007). The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. The Journal of Behavioural Medicine, 30(1), 77–94.
13. Lindenhovius, A.L., Buijze, G.A., Kloen, P., & Ring, D.C. (2008). Correspondence between perceived disability and objective physical impairment after elbow trauma. The Journal of Bone and Joint Surgery. American volume, 90(10), 2090–2097.
14. Loeser, J.D., & Treede, R.D. (2008) The Kyoto protocol of IASP Basic Pain Terminology. Pain, 137(3), 473–477.
15. Luime, J.J., Koes, B.W., Hendriksen, I.J., Burdorf, A., Verhagen A.P., Miedema, H.S., & Verhaar, J. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology, 33(2), 73–81.
16. MacDermid, J.C., Solomon, P., & Prkachin, K. (2006). The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskeletal Disorders, 7, 12.
17. Martinez-Calderon, J., Meeus, M., Struyf, F., Miguel Morales-Asencio, J., Gijon-Nogueron, G., & Luque-Suarez, A. (2018). The role of psychological factors in the perpetuation of pain intensity and disability in people with chronic shoulder pain: a systematic review. BMJ Open, 8(4), e020703.
18. Meeus, M., Nijs, J., Van de Wauwer, N., Toeback, L., & Truijen, S. (2008). Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: an experimental study. Pain, 139(2), 439-448.
19. Meyer, R.A., Campbell, J.N., & Raja, S.N. (1995) Peripheral neural mechanisms of nociception. In Wall, P.D., Melzack, R. (Ed.). Textbook of pain. 3rd ed., pp.13-44. Edinburgh: Churchill Livingstone.
20. Mogil, J. S. (2012). Pain genetics: past, present and future. Trends in Genetics, 28(6), 258–266.
21. Neblett, R., Cohen, H., Choi, Y., Hartzell, M. M., Williams, M., Mayer, T. G., & Gatchel, R. J. (2013). The central sensitization inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. Journal of Pain, 14(5), 438-445.
22. Neblett, R., Hartzell, M.M., Cohen, H., Mayer, T.G., Williams, M., & Choi, Y. (2015) Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample. The Clinical Journal of Pain, 31(4), 323–32.
23. Nijs, J., Van Houdenhove, B., & Oostendorp, R.A. (2010). Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Manual Therapy, 15(2), 135–141.
24. Noten, S., Struyf, F., Lluch, E., D’ Hoore, M., Van Looveren, E., & Meeus, M. (2017). Central pain processing in patients with chronic shoulder pain: a systematic literature review. Pain Pract, 17(2):267-280.
25. Perruccio, A.V., Davis, A.M., Hogg-Johnson, S., & Badley, E.M. (2011). Importance of self-rated health and mental wellbeing in predicting health outcomes following total joint replacement surgery for osteoarthritis. Arthritis Care & Research, 63(7), 973–981.
26. Roach, K.E., Budiman-Mak, E., Songsiridej, N., & Lertratanakul, Y. (1991) Development of a shoulder pain and disability index. Arthritis Care & Research, 4(4), 143-149.
27. Roe, Y., Soberg, H. L., Bautz-Holter, E., & Ostensjo, S. (2013). A systematic review of measures of shoulder pain and functioning using the International classification of functioning, disability and health (ICF). BMC Musculoskeletal Disorders, 14, 73.
28. Rosenstiel, A.K., & Keefe, F.J. (1983). The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain, 17(1), 33–44.
29. Sanchis, M.N., Lluch, E., Nijs, J., Struyf, F., & Kangasperko, M. (2015). The role of central sensitization in shoulder pain: A systematic literature review. Seminars in Arthritis and Rheumatism, 44(6), 710-716.
30. Staud, R., Craggs, J.G., Robinson, M.E., Perlstein, W.M., & Price, D.D. (2007). Brain activity related to temporal summation of C-fiber evoked pain. Pain, 129 (1-2),130-142.
31. Steimer, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues Clinical Neuroscience, 4(3), 231–49.
32. Sullivan, M.J., Bishop, S.R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological Assessments, 7(4), 542-532.
33. Turk, D.C., & Wilson, H.D. (2010) Fear of pain as a prognostic factor in chronic pain: conceptual models, assessment, and treatment implications. Curr Pain and Headache Reports, 14, 88–95.
34. Vardeh, D, Mannion, R.J., & Woolf, C.J. (2016). Toward a Mechanism-Based Approach to Pain Diagnosis. The Journal of Pain,17, 50-69.
35. Van der Windt, D.A., Koes, B.W., Boeke, A.J., Deville, W., De Jong, B.A., & Bouter, L.M. (1996). Shoulder disorders in general practice: prognostic indicators of outcome. The British Journal of General Practice, 46(410), 519–23.
36. Vlaeyen, J.W., & Linton, S.J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85:317–32.
37. Vranceanu, A.M., Barsky, A., & Ring, D. (2009). Psychosocial aspects of disabling musculoskeletal pain. The Journal of Bone and Joint Surgery. American volume, 91(8), 2014–2018.
38. Woolf, C.J. (1983). Evidence for a central component of post-injury pain hypersensitivity. Nature, 306(5944), 686-8.
39. Woolf, C.J. (2010). What is this thing called pain? The Journal of Clinical Investigation, 120(11), 3742–3744.
40. Woolf, C.J. (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain,152, S2–S15.