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Fear of Pain Influences Outcomes After Exercise-induced Delayed Onset Muscle Soreness at the Shoulder

George, Steven Z. PT, PhD*; Dover, Geoffrey C. PhD, ATC; Fillingim, Roger B. PhD

The Clinical Journal of Pain: January 2007 - Volume 23 - Issue 1 - p 76-84
doi: 10.1097/01.ajp.0000210949.19429.34
Original Articles

Objectives This study investigated whether anxiety, fear of pain, or pain catastrophizing were predictive of pain-related outcomes after induced delayed onset muscle soreness (DOMS) at the shoulder.

Methods Healthy participants (19 males and 23 females) were eligible for participation if they had (a) no history of neck or shoulder pain, (b) no sensory or motor impairments of the upper-extremity, (c) not regularly participating in upper-extremity weight training, (d) not currently or regularly taking pain medication, and (e) no history of upper-extremity surgery. Participants completed self-report measures for fear of pain, pain catastrophizing, and anxiety. Then, participants underwent a standard fatigue protocol to induce DOMS in the shoulder external rotator muscles. Participants were reassessed 24 hours after DOMS induction on clinical and evoked pressure pain reports, muscle force production, self-report of upper-extremity disability, and kinesiophobia. Stepwise regression models considered sex, anxiety, pain intensity, fear of pain, and pain catastrophizing as outcome predictors.

Results Fear of pain alone explained 16% (P=0.008) of the variance in clinical pain and 10% (P=0.047) evoked pressure pain intensity. Clinical pain intensity alone explained 11% (P<0.031) of the variance in muscle force production. Clinical pain intensity and fear of pain explained 50% (P<0.001) of the variance in upper-extremity disability, whereas fear of pain and sex accounted for 26% (P=0.005) of the variance in kinesiophobia.

Conclusions With the exception of muscle force production, fear of pain had a consistent influence on shoulder DOMS outcomes, even after controlling for pain intensity. This study suggests fear of pain may be a relevant psychologic factor to consider in clinical studies investigating the development and treatment of chronic shoulder pain.

*Department of Physical Therapy, Brooks Center for Rehabilitation Studies

Department of Applied Physiology and Kinesiology

Division of Public Health Services and Research, University of FL

The University of Florida Research Opportunity Incentive Seed Fund supported a portion of this study.

Reprints: Steven Z. George, PT, PhD, PO Box 100154, University of Florida, Gainesville, FL 32611-0154 (e-mail:

Received for publication April 21, 2006; accepted September 4, 2006

A portion of data from this manuscript was presented at the 2006 American Pain Society annual meeting in San Antonio, TX.

The institutional review board at the University of Florida approved this study.

© 2007 Lippincott Williams & Wilkins, Inc.