Pain drawings in people with frozen shoulder contracture syndrome: which pain mechanisms might be in play?

Barbero, Marco and Falla, Deborah and Dueñas, Lirios and Balasch, Mercè and Aguilar, Marta and Cescon, Corrado and Schneebeli, Alessandro and Lluch Girbés, Enrique (2019) Pain drawings in people with frozen shoulder contracture syndrome: which pain mechanisms might be in play? UNSPECIFIED. In: WCPT2019 Proceedings World Confederation for Physical Therapy Congress, 2019, May 10th-13th, Geneva, Switzerland.

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Abstract

Background: Understanding which pain mechanisms underlie patients symptoms is relevant to select the most appropriate intervention for people suffering from musculoskeletal pain. Nociceptive pain typically presents with a local pain distribution in the injured area in contrast to an expanded pain distribution, which is characteristic of dominant central pain mechanisms. Pain drawings can be useful to record the distribution of pain and thus inform about the underlying pain mechanisms. Purpose: To investigate the distribution of pain in people with frozen shoulder contracture syndrome (FSCS) and to examine the association between the extent of pain and pain intensity, pain catastrophizing, and scores on the Central Sensitization Inventory. Methods: 48 people with FSCS participated in this study and completed their pain drawings using a digital tablet. They also completed questionnaires (Pain Catastrophizing Scale, Central Sensitization Inventory) and recorded their current pain intensity (Visual Analogue Scale). Pain extent and pain location were computed using the Margolis rating scale. Spearman's correlation coefficients were performed to reveal possible correlations between the extent of pain and pain intensity, pain catastrophism and scores on the Central Sensitization Inventory. Results: All the patients reported pain in the anterior shoulder region. Moreover, a significant percentage reported pain in the adjacent regions like the scapular region (72.9%), the anterior portion of the arm (87.5%) and the posterior neck region (54.2%). Significant positive correlations were observed between pain extent and pain intensity, pain catastrophizing and central sensitization. Conclusion(s): In patients with frozen shoulder pain is mainly reported in the shoulder region suggesting a nociceptive pain mechanism. The positive correlation with the central sensitization and the pain catastrophizing suggests that in patients with widespread pain a central pain mechanism can also occur. Implications: Pain drawings may help clinicians to determine pain mechanisms in the evaluation of patients with chronic musculoskeletal pain.

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