Emotional distress was associated with persistent shoulder pain after physiotherapy: a prospective cohort study

Abstract

BackgroundThere is a paucity of research on the association between psychological factors and persistent shoulder pain. The aim of this study was to investigate whether emotional distress was associated with pain intensity and self-reported disability after physiotherapy treatment in patients with shoulder pain.MethodsData from 145 patients treated at physiotherapy outpatient clinics aged ≥18 years with self-reported pain in the shoulder or arm, and movement activity problems related to the upper-extremity, were included. Outcome measures were pain intensity measured by Numeric Pain Rating Scale and disability measured by Patient Specific Functional Scale. Demographic and clinical characteristics, including emotional distress measured by Hopkins Symptom Checklist – 25, were obtained at study onset. Association between characteristics at study onset and pain and disability after physiotherapy treatment were analysed using multiple linear regression and a backward manual elimination method. The final models were adjusted for age and sex.ResultsHigher emotional distress at study onset (B 1.06, 95% CI 0.44 to 1.68) was associated with higher pain intensity after the physiotherapy treatment (P = 0.001). Emotional distress was not associated with self-reported disability after the physiotherapy treatment.ConclusionThis study found that emotional distress at study onset was associated with shoulder pain intensity after physiotherapy treatment, but not with disability. The findings indicate that emotional distress should be included in the initial physiotherapy examination of shoulder pain.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2142-3) contains supplementary material, which is available to authorized users.

Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review

“…No difference was found for arthropathies, fractures, sprains and strains, postsurgical conditions. Smedbråten et al, 2018 [ 49 ] (++) Pain (NRS) Function (PSFS) + - In final multiple regression model, emotional distress (HSCL-25) associated with more pain (Beta 1.06, 95% CI 0.44–1.68, p = 0.001). Other significant predictors: pain intensity before treatment, duration of pain > 12 months.…”

“…Cohort Primary care and PT clinics, U.K. Shoulder pain NR 222 (of 375 with arm pain) NR Various interventions NR 12 months 17% (of total population) Subjective pain report Sindhu et al 2012 [ 48 ] Retro. analysis of prosp.collected data Outpatient rehab clinics, various locations throughout the United States Shoulder impairment NR 3362 (54%) 54 Conservative care NR End of treatment 53% Shoulder function (CAT) Smedbråten et al 2018 [ 49 ] Registry study Outpatient Physiotherapy Norway, FysioPol database Shoulder impairment NR 145 (72%) 44 Exercises physiotherapy 5 weeks (IQR 3 to 6) End of treatment NA Pain (NRS) Function (PSFS) Van der Windt et al 2007 [ 50 ] Prosp. Cohort Primary care clinic, Netherlands Acute shoulder pain NR 344 (48%) 51 Usual care by GP (Group 1), including steroid injection if indicated (Group 2) NR 3 Months 12% Perceived recovery (VAS), Disability (SDQ) Wolfensberger et al 2016 [ 51 ] Retro.…”

“…High: [36] High: [36,43] Moderate: [38] Not specified / mixed Yes High: [34] High: [34,45] High: [46] Moderate: [48] High: [40,49] No…”

Opioid Consumption in Chronic Pain Patients: Role of Perceived Injustice and Other Psychological and Socioeconomic Factors

“…Mark D. Sullivan emphasizes that "long-term opioid therapy impairs human social and emotional functions" [8]. Pain-related distress has been shown to increase pain intensity and interference [53][54][55] and to be associated with worse outcomes in treatment studies [56].…”

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“…It has long been argued that RCTs should include standardized measures of pain intensity, pain‐related interference and some measure of psychological functioning or distress (Chiarotto et al, ; Koes et al, ). Pain‐related distress has been shown to increase pain intensity and interference (Nordstoga, Vasseljen, Meisingset, Nilsen, & Unsgaard‐Tøndel, ; Smedbråten, Øiestad, & Røe, ), and to be associated with worse outcomes in treatment studies (Helminen, Sinikallio, Valjakka, Väisänen‐Rouvali, & Arokoski, ; Smedbråten et al, ). As a result, the IMMPACT (Dworkin et al, ) (for adults) and PedIMMPACT (McGrath et al, ) (for children and adolescents) guidelines recommend measuring several dimensions, such as pain, physical functioning, emotional functioning, participant ratings of global improvement and adverse events.…”