200 Section - Multidimensional Analysis of the Clinical Spectrum and Symptom Burden of Myofascial Pain

Pain quality and severity vary widely for people with myofascial pain (MP), making it difficult to accurately select outcome measures.  We assessed potential contributors to symptom variability for pain reporting to define the clinical spectrum and symptom burden of neck/shoulder pain and classify MP. 


Design: Prospective, cross-sectional study involving adults with neck/shoulder pain and pain-free individuals

Results:

82 had complete records (age 32.2 years, 57% women). 23 were assigned to a spontaneously symptomatic group (SS; pain without provocation), and 59 were currently asymptomatic group (CA; including those with pain upon provocation).   

Physical Function(PF) and Pain catastrophizing(PCS) are predictors of PEG (pain interference and intensity)(p < 0.0001 and p = 0.0006, respectively). PCS predicts both SS (p < 0.02) and CA (p < 0.01) groups, while PF (p = 0.025) and depression (p = 0.04) are important in the CA group. Selected variables explained 74% of the variance in PEG in all, 85% in the SS group. In SS group, PF is negatively linked with hypermobility (-0.43) and PEG (-0.37); while PCS is positively linked to PEG (0.38) and anxiety (0.36). PPT negatively correlates with quantitative sensory testing (-0.30). These measures differentiated the SS and CA groups with 87% accuracy (92% sensitivity, 74% specificity). 


Conclusion: Selected PROs and objective measures explain a spectrum of symptoms of neck/shoulder girdle pain in people with MP. Further, this combination of evaluations successfully distinguish between participants with spontaneously symptomatic pain and those who are currently asymptomatic. Network analysis can demonstrate important interconnections among multiple domains and suggest that including measures of depression, anxiety as well and other PROs and objective measures may offer an approach to treatment that is effective in reducing the symptom burden and improving physical function.