Do psychosocial factors predict the persistence of shoulder pain?

Abstract

Background and aims: The key mechanisms involved in the development of persistent shoulder pain are still not clearly understood. Even if psychosocial factors have been shown to be associate with chronicization of musculoskeletal pain, few studies have explored the impact of these factors in the persistence of rotator cuff related shoulder pain (RCRSP). The aim of this study was to identify the psychosocial risk factors associated with persistence of pain in individuals with RCRSP after an education program targeting shoulder pain self-management. Methods: Fifty-nine participants with persistent RCRSP completed this study (43.9±11.5years; 61%women; 70% had pain duration > 1year). Using the RedCap web application, all participants filled questionnaires covering a biopsychosocial spectrum: Brief Resilience Scale (BRS), Perceived Stress Scale (PSS-10), Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Patient-Health Questionnaire – 9 (PHQ-9), General Anxiety Disorder – 7 (GAD-7), Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ) and Multidimensional Scale of Perceived Social Support (MSPSS). Thereafter, participants took part in an educational program aimed at promoting self-management of shoulder pain that included two meetings with a physiotherapist. After 3 months, participants filled the QuickDASH and, based on their scores, were classified as having persistent shoulder pain (score>11) or as recovered (score=0-11). Results: The symptoms of 24 participants (~41%) were considered resolved at 3 months. A binomial logistic regression demonstrated that only PSEQ was associated with symptoms resolution (p=.04). Lower level of self-efficacy was associated with persistent pain at 3 months (Odds Ratio= 1.08 95%Confidence Interval (CI): 1.00, 1.17. No variables predicted persistent RCRSP. Conclusions: Pain self-efficacy was the most important factor in avoiding the development of persistent RCRSP.