The association between pain beliefs and pain intensity and/or disability in people with shoulder pain: A systematic review.

BACKGROUND: Pain beliefs might play a role in the development, transition, and perpetuation of shoulder pain.

OBJECTIVE: To systematically review and critically appraise the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain.

METHODS: An electronic search of PubMed, EBSCOhost, AMED, CINAHL, EMBASE, and PubPsych, and grey literature was searched from inception to July 2017. Study selection was based on observational studies exploring the association and the predictive value of pain beliefs on pain intensity and/or disability in shoulder pain.

RESULTS: A total of thirty-three articles were included with a total sample of 10,293 participants with shoulder pain. In the cross-sectional analysis, higher levels of pain catastrophizing and kinesiophobia were significantly associated with more pain intensity and disability, whereas higher levels of expectations of recovery and self-efficacy were significantly associated with lower levels of pain intensity and disability. In the longitudinal analysis, higher levels of pain catastrophizing, fear-avoidance and kinesiophobia at baseline predicted greater pain intensity and disability overtime. Higher levels of self-efficacy and expectations of recovery at baseline predicted a reduction in levels of pain intensity and disability overtime.

CONCLUSIONS: Evidence suggests that pain beliefs are associated with and predict the course of pain intensity and disability in shoulder pain. However, the overall body of the evidence after applying the GRADE approach was very low across studies. Further research using higher quality longitudinal designs and procedures would be needed to establish firm conclusions.