Abstract
The aim of this cross-sectional study was to explore the spatial extent of pain and its association with clinical symptoms, psychological features, and pain sensitization in people with frozen shoulder (FS). Forty-eight individuals with FS completed pain drawings (PDs) and reported their clinical symptoms including pain intensity (Visual Analogue Scale) and shoulder disability (Shoulder Pain and Disability Index). Moreover, pain sensitization measurements (pressure pain thresholds, temporal summation, conditioned pain modulation, and Central Sensitization Inventory (CSI)) were assessed. Psychological features were assessed by Pain Catastrophizing Scale (PCS) and Pain Vigilance and Awareness Questionnaire. Pain frequency maps were generated, Margolis rating scale was used for pain location, and Spearman correlation coefficients were computed. The mean (SD) pain extent was 12.5% (6.7%) and the most common painful area was the anterolateral shoulder region (100%). Women presented a more widespread pain distribution compared with men. Significant positive associations were obtained between pain extent and current pain intensity (rs = 0.421, p < 0.01), PCS (rs = 0.307, p < 0.05) and CSI (rs = 0.358, p < 0.05). The anterolateral region of the shoulder was the most common painful area in people with FS. Women with FS presented more extended areas of pain; and a more widespread distribution of pain was correlated with higher levels of pain, pain catastrophizing and pain sensitization.
Highlights
Introduction distributed under the terms andFrozen shoulder (FS) is a frequent musculoskeletal disorder which is characterized by progressive loss of shoulder range of motion [1]
No statistically significant correlations were observed between pain extent and pressure pain thresholds (PPTs) at the affected shoulder, Temporal summation (TS) or conditioned pain modulation (CPM), while a low positive correlation was found between pain extent and Central Sensitization Inventory (CSI); participants with a larger pain extent showed higher scores in the CSI
The results of this study showed no significant association between pain extent and pain sensitization outcomes (PPTs, TS and CPM) with the exception of the CSI
Summary
Introduction distributed under the terms andFrozen shoulder (FS) is a frequent musculoskeletal disorder which is characterized by progressive loss of shoulder range of motion [1]. The role of lowgrade inflammation and immune system response dysregulation leading to pathological changes in the shoulder capsule is gaining interest in the scientific literature [2,3]. At early stages of the pathology, an immune response with elevated levels of alarmins has been found in the shoulder capsule of people with FS, triggering a cascade of inflammation and leading to subsequent fibrosis of the capsular tissue [14]. These mechanisms appear to be perpetuated by an upregulated production of pro-inflammatory cytokines and a neuro-immune activation [15,16]. A deeper understanding of pain mechanisms is considered essential for reaching accurate diagnosis and treatment approaches [19]
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