Department of Physical Therapy, Rehabilitation Science Doctoral Program, University of Florida, Gainesville, Florida.
Department of Rheumatology and Clinical Immunology, University of Florida, Gainesville, Florida.
J Pain. 2021 Jun;22(6):669-679. doi: 10.1016/j.jpain.2020.12.002. Epub 2021 Jan 2.
Our prior studies identified a high-risk phenotype (ie, high pain sensitivity variant of the catechol-O-methyltransferase gene (Single Nucleotide Polymorphism [SNP] rs6269) and pain catastrophizing scores) for shoulder pain. The current study identified sensory and psychological predictors of heightened pain responses following exercise-induced shoulder injury. Healthy participants (N = 131) with the SNP rs6269 catechol-O-methyltransferase gene and Pain Catastrophizing Scale scores ≥5 underwent baseline sensory and psychological testing followed by an established shoulder fatigue protocol, to induce muscle injury. Movement-evoked pain, pain intensity, disability, and strength were assessed 24 hours postinjury. Demographic, sensory, and psychological variables were included as predictors in full and parsimonious models for each outcome. The highest variance explained was for the shoulder disability outcome (full model R = .20, parsimonious R = .13). In parsimonious models, the individual predictors identified were: 1) 1st pulse heat pain sensitivity for isometric shoulder movement-evoked pain and pain intensity; 2) pressure pain threshold for shoulder disability; 3) fear of pain for active shoulder movement-evoked pain and shoulder disability; and 4) depressive symptoms for shoulder strength. Findings indicate specific pain sensitivity and psychological measures may have additional prognostic value for self-reported disability within a high-risk phenotype. These findings should be tested in a clinical cohort for validation. PERSPECTIVE: The current study extends previous work by providing insight regarding how poor shoulder outcomes may develop within a high-risk phenotype. Specifically, 1st pulse heat pain sensitivity and pressure pain threshold were sensory measures, and fear of pain and depressive symptoms were psychological measures, that improved prediction of different shoulder outcomes.
我们之前的研究确定了一种高风险表型（即，儿茶酚-O-甲基转移酶基因（单核苷酸多态性 [SNP] rs6269）的高疼痛敏感性变体和疼痛灾难化评分）与肩痛有关。本研究确定了运动引起的肩伤后疼痛反应加剧的感觉和心理预测因子。具有 SNP rs6269 儿茶酚-O-甲基转移酶基因和疼痛灾难化量表评分≥5 的健康参与者（N=131）进行基线感觉和心理测试，然后进行既定的肩部疲劳方案，以诱导肌肉损伤。损伤后 24 小时评估运动诱发的疼痛、疼痛强度、残疾和力量。将人口统计学、感觉和心理变量作为每个结果的完整和简约模型的预测因子。解释方差最高的是肩部残疾结果（完整模型 R=0.20，简约模型 R=0.13）。在简约模型中，确定的个体预测因子为：1）第一脉冲热痛觉用于等长肩部运动诱发的疼痛和疼痛强度；2）肩部残疾的压痛阈值；3）对疼痛的恐惧用于主动肩部运动诱发的疼痛和肩部残疾；4）抑郁症状用于肩部力量。研究结果表明，特定的疼痛敏感性和心理测量可能在高风险表型内对自我报告的残疾具有额外的预后价值。这些发现应在临床队列中进行验证。观点：本研究通过提供有关高风险表型内不良肩部结果如何发展的见解，扩展了之前的工作。具体来说，第一脉冲热痛觉和压痛阈值是感觉测量，而对疼痛的恐惧和抑郁症状是心理测量，这提高了对不同肩部结果的预测能力。
