Suzie Noten1,2, Filip Struyf1, Enrique Lluch2,3, Marika D'Hoore1, Eveline Van Looveren1, Mira Meeus1,2,4. 1. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain. 2. Pain in Motion International Research Group, Antwerp, Belgium. 3. Department of Physical Therapy, University of Valencia, Valencia, Spain. 4. Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Abstract
BACKGROUND: Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients. METHODS: The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies. RESULTS: Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particular, quantitative sensory testing revealed hyperalgesia for pressure pain in the MSK group, whereas these results were inconsistent in patients with HSP. Conditioned pain modulation was reduced in patients with MSK shoulder pain, but functioned normally in the HSP group. CONCLUSION: This review has shown that great progress has been made toward a better understanding of neurophysiologic pain mechanisms in patients with shoulder pain. The presence of generalized mechanical hyperalgesia, allodynia, and impaired conditioned pain modulation in patients with MSK shoulder pain indicates the involvement of the central nervous system. Widespread somatosensory abnormalities observed in patients with HSP could suggest a central origin for their shoulder pain and predispose patients with HSP to develop CS, although results are inconsistent. Additional research is required adopting different assessment methods (especially dynamic methods) to establish the role of CS in patients with shoulder pain.
BACKGROUND: Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients. METHODS: The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies. RESULTS: Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particular, quantitative sensory testing revealed hyperalgesia for pressure pain in the MSK group, whereas these results were inconsistent in patients with HSP. Conditioned pain modulation was reduced in patients with MSK shoulder pain, but functioned normally in the HSP group. CONCLUSION: This review has shown that great progress has been made toward a better understanding of neurophysiologic pain mechanisms in patients with shoulder pain. The presence of generalized mechanical hyperalgesia, allodynia, and impaired conditioned pain modulation in patients with MSK shoulder pain indicates the involvement of the central nervous system. Widespread somatosensory abnormalities observed in patients with HSP could suggest a central origin for their shoulder pain and predispose patients with HSP to develop CS, although results are inconsistent. Additional research is required adopting different assessment methods (especially dynamic methods) to establish the role of CS in patients with shoulder pain.
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