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Experimental Pain Responses Support Peripheral and Central Sensitization in Patients With Unilateral Shoulder Pain

Coronado, Rogelio A. PT, CSCS, FAAOMPT*; Simon, Corey B. PT, DPT, FAAOMPT*; Valencia, Carolina PT, PhD; George, Steven Z. PT, PhD*,‡

doi: 10.1097/AJP.0b013e318287a2a4
Original Articles

Objective: The aims of this study were to (1) examine the pattern of experimental pain responses in the affected and nonaffected extremities in patients with shoulder pain and (2) explore the intraindividual association between sensitization states derived from experimental pain testing.

Methods: Experimental pain responses from 58 patients with shoulder pain (17 women, aged 18 to 52 y) were compared with those from 56 age-matched and sex-matched pain-free volunteers (16 women, aged 21 to 58 y). Experimental pain responses included pressure pain threshold (PPT), thermal pain threshold and tolerance, and suprathreshold heat pain response. Comparisons were made between the affected and nonaffected extremities of clinical participants and the average response of extremities in control participants. Peripheral and central sensitization indexes were computed for clinical participants using standardized scores and percentile cutoffs on the basis of the data from the control sample. Experimental pain responses in clinical participants observed beyond the 25th and 75th percentile of control sample responses were used for investigation of intraindividual association of sensitization states.

Results: PPT at the acromion and masseter on the affected side of clinical participants were diminished compared with that on their nonaffected side (P<0.015). Bilateral sensitivity in clinical participants was noted for PPT at the acromion and suprathreshold heat pain response (P<0.015). Peripheral and central sensitization indexes demonstrated that individuals with shoulder pain present with variable patterns of peripheral and central sensitization.

Conclusions: Collectively, experimental pain responses supported peripheral and central sensitization in response to pressure and thermal stimuli. No clear association was made between individuals exhibiting peripheral or central sensitization, thus suggesting heterogeneity in pain processing in this clinical population.

*Department of Physical Therapy, College of Public Health and Health Professions

Center for Pain Research and Behavioral Health, University of Florida, FL

Department of Applied Medicine and Rehabilitation, Indiana State University, IN

Supported by NIAMS/NIH grant AR055899. Mr. Coronado acknowledges support from NIH T32 Interdisciplinary Training in Rehabilitation and Neuromuscular Plasticity grant 5T32HD043730. The authors declare no conflict of interest.

Reprints: Rogelio A. Coronado, PT, CSCS, FAAOMPT, Box 100154, UFHSC, Gainesville, FL 32610-0154 (e-mail:

Received March 4, 2012

Accepted January 12, 2013

© 2014 by Lippincott Williams & Wilkins