Cognitive Behavioral Factors and Central Sensitization in Chronic Shoulder Pain

Study Overview
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Brief Summary
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The objective of this study is to examine the relationship between symptoms of central sensitization (CS) and important cognitive behavioral and psychosocial factors in patients with chronic shoulder pain.

Detailed Description
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Participants, both male and female, with chronic shoulder pain for at least 3 months will be included in the study. They will complete several questionnaires and a functional test. Spearman's correlation will be used to analyze associations between symptoms of CS and pain behavior, functioning, pain, pain catastrophizing, kinesiophobia, and illness perceptions. Additionally, a between-group analysis will be performed to compare patients with and without clinically relevant symptoms of CS.

Official Title
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Correlation Between Symptoms of Central Sensitization and Cognitive Behavioral Factors in People With Chronic Shoulder Pain

Conditions
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Chronic Shoulder Pain

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: (1)chronic unilateral shoulder pain (Chronic pain will be defined as pain lasting for 3 or more months. Also, pain intensity will be at least 3 on a 0-10 numerical pain rating scale on most days of the last 3 months). Exclusion Criteria: recent shoulder dislocation (1 year prior) and/or systemic diseases such as rheumatoid arthritis, fibromyalgia and/or polymyalgia rheumatic shoulder pain considered to be originated from the cervical region, and other traumas, neurological dysfunction (ie, multiple sclerosis or stroke), osteoporosis, haemophilia and/or cancer shoulder surgery participants with shoulder pain after post fracture Being pregnant or given birth in the preceding year Overconsumption of alcohol or any other recreational drug2 Cognitive impairment inability to provide informed consent and/or complete written questionnaires If participants use medication with a known influence on the central nervous system (eg, anti-epileptic and antidepressant, analgesics, and/or NSAID's), it should be stable in medication intake for at least 1 month prior to his/her participation to be included in this study (Kuppers et al. 2017). Patients are required to continue usual care at least 6 weeks prior to study participation to obtain a steady state.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Central sensitization symptoms<br>This group will contain persons with a clinically relevant degree of symptoms of CS (CSI score ≥40). | |
| No Central sensitization symptoms<br>This group will contain persons with a lower degree of symptoms of CS (CSI score < 40). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Central sensitization inventory (CSI) | The CSI contains a part A of 25 statements related to current health symptoms, indicative of central sensitisation (scored on a 5-point Likert scale ranging from 0-4). A mean score of 40 is the cut off value for central sensitization (Neblett et al 2013). The CSI has proven psychometric strength (Mayer et al 2012; Neblett et al. 2018). | 10 min | 
| Oxford Shoulder Score (OSS) | The Oxford Shoulder Score (OSS) is a 12-item patient-reported outcomespecifically designed and developed for assessing the impact on patients' quality of life of degenerative conditions such as arthritis and rotator cuff problems. Substantial evidence from clinical studies shows that the PRO has high internal consistency and is a valid and reliable measure of patient well-being. The intraclass correlation has been calculated as 0.83 (Ekeberg,2008 ). In this study, • Self-report functional will be assessed with the Oxford Shoulder Score. | 10 min | 
| Tampa Scale for Kinesiophobia | To measure kinesiophobia, the Tampa Scale for Kinesiophobia was used. Patients have to score 17 opinions on a 4-point Likert scale (1 = highly disagree, 4 = highly agree). Scores ≥37/68 indicate kinesiophobia. This questionnaire has good internal consistency and test-retest reliability. | 10 min | 
| Hospital Anxiety and Depression Scale (HADS) | Hospital Anxiety and Depression Scale (HADS) is commonly used to determine the levels of anxiety and depression. The HADS is a fourteen item scale that generates ordinal data. Seven of the items relate to anxiety and seven relate to depression. A number of researchers have explored HADS data to establish the cut-off points for caseness of anxiety or depression. Bjelland et al (2002)[2] through a literature review of a large number of studies identified a cut-off point of 8/21 for anxiety or depression. For anxiety (HADS-A) this gave a specificity of 0.78 and a sensitivity of 0.9. For depression (HADS-D) this gave a specificity of 0.79 and a sensitivity of 0.83. | 10 min | 
| Pain Catastrophizing Scale | To measure the extent of pain catastrophizing, we will be used the Pain Catastrophizing Scale, which consists of 13 items exploring pain-related cognition, which the patient has to score on a 5-point Likert scale (0 = not at all, 4 = all the time). Scores ≥30/52 reveal a clinically relevant degree of catastrophizing. This questionnaire is found to have good internal consistency and test-retest reliability, as well as proven construct and criterion validity. | 10 min | 
| Brief Illness Perception Questionnaire | Patients' illness perceptions will be measured based on the Brief Illness Perception Questionnaire. The patient has to rate 8 statements on a 10-point scale (1-10). The higher the score, the greater is the extent to which the patient's illness perceptions are threatening him or her. | 3 min | 
| Arm Endurance Test | Pain behavior will be assessed using the arm Endurance Test. This test measured the time the patient could hold both arms horizontally out to the side describing small circles. The tester continued timing while the fingers remained above a line level with the elbow when the arm was dependent (Hardind et al. 1994). | 5 min | 
| Numeric Pain Rating Scale | The Numeric Pain Rating Scale (NPRS) is a unidimensional measure of pain intensity in adults. The most commonly used is the 11-item NPRS. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable).The NPRS is a valid and reliable scale to measure pain intensity. In this study, will rate current pain intensity and mean pain intensity durind the past 7 days. | 1 min | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CSI, kinesiophobia, Central Nervous System Sensitization, Catastrophizing, Illness Behavior