Pro-nociceptive pain modulation profile in patients with acute and chronic shoulder pain: a hypothesis-generating topical review

Abstract

Shoulder pain is a common musculoskeletal complaint associated with a significant impact on health and socioeconomic outcomes. Current evidence indicates a poor understanding of the mechanisms driving shoulder pain experience. The heightened nociceptive processing (pro-nociceptive pain modulation profile) within the central nervous system could explain variability in the shoulder pain experience. This topical review and hypothesis-generating paper discuss the current evidence and gaps regarding abnormal nociceptive processing in patients with shoulder pain. This paper also proposes hypotheses to test the presence of a pro-nociceptive pain modulation profile by measuring the pain responses to conditioned pain modulation, mechanical temporal summation and movement-evoked pain procedures. Moreover, this paper proposes whether a pro-nociceptive pain modulation profile can explain the variability in the pain experience in people with shoulder pain. Gaining insights into the abnormal nociceptive processing in people with acute and chronic shoulder pain will guide future research and clinical practice to improve shoulder pain outcomes.

Keywords:

• Shoulder pain
• somatosensory abnormalities
• quantitative sensory testing
• pain modulation profile
• movement-evoked pain

Disclosure statement

No potential conflict of interest was reported by the authors. This review protocol is a part of an ongoing PhD thesis (Rani Othman).

Additional information

Notes on contributors

Rani Othman

Rani Othman is a PhD student at the Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand. As part of the PhD thesis, he is investigating the relationships between somatosensory abnormalities and psychosocial factors in patients with musculoskeletal pain.

Nicola Swain

Nicola Swain is Associate Professor at the Psychological medicine, Dunedin School of Medicine, University of Otago. Nicola was the President of the New Zealand Pain Society. Her research is focused on understanding and management chronic pain conditions.

Steve Tumilty

Steve Tumilty is Associate Professor at the School of physiotherapy, University of Otago, New Zealand. Tumilty’s research is focused on intervention studies combining clinical outcomes with physiological outcomes related to musculoskeletal and sports injuries.

Prasath Jayakaran

Prasath Jayakaran is a lecturer at the School of physiotherapy, University of Otago, New Zealand. Prasath’s main focus of research is around balance, particularly around peripheral sensory information processing. He is the lead researcher for balance and vestibular research at the School of physiotherapy.

Ramakrishnan Mani

Ramakrishnan Mani is a senior lecturer at the School of physiotherapy, University of Otago, New Zealand. He is the deputy director of the pain@otago research theme and the lead of pain education research subtheme. Ram’s primary research interest is to profile bio-psycho-social pain mechanisms for developing targeted management of musculoskeletal pain. Other key research areas include life-course predictors of pain development and chronicity, and pain education.