Archives of physical medicine and rehabilitation · 2026
Multidimensional Analysis of the Clinical Spectrum and Symptom Burden of Unexplained Myofascial Pain.
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Sikdar Siddhartha, DeStefano Secili, Guzmán-Pavón María José, Hsu Yu-Lin, Lee Seiyon, Srbely John, Shah Jay, Rosenberger William, Acuña Samuel, Assefa Yonathan, Jahani Jirsaraei Matin, Stecco Antonio, Gerber Lynn H
Аннотация
OBJECTIVE: To assess potential contributors to the variability in the clinical spectrum of unexplained neck/shoulder pain and its associated myofascial component(s).
DESIGN: Prospective cross-sectional study of adults reporting neck/shoulder pain and pain-free individuals.
SETTING: Participants were recruited from the community and assessed in a research laboratory.
PARTICIPANTS: Of the N=96 adults recruited for the study, 84 had complete records (mean age±SD, 32.7±13.2 y; 58.3% women). On physical examination, they were classified into an active group (those with spontaneous MP without provocation, n=25), a latent group (those with MP upon provocation, n=38), or a referent group (those with no MP in the neck and shoulder, n=21).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Pain intensity and interference; symptom burden measured using patient-reported outcomes and objective measures: Pain Catastrophizing Scale (PCS); Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function; sleep disturbance; anxiety; depression; hypermobility (Beighton/Brighton); objective measures in the medial upper trapezius using pressure pain threshold and quantitative sensory testing.
RESULTS: The symptom burden explained 75% of the variance in pain intensity and interference in the overall sample, 82% in the active group, and 92% in the referent group. PROMIS Physical Function and PCS were key predictors of pain intensity and interference. Network analysis identified unique symptom clusters in the active and latent groups.
CONCLUSIONS: Multidimensional symptom burden explains the variability in the clinical spectrum of pain intensity and interference in unexplained neck/shoulder MP. Network analysis can further improve clinical risk stratification. These findings represent a step toward the eventual goal of developing multidisciplinary clinical guidance for managing the whole patient, rather than the current emphasis on regional contributors to MP.
DESIGN: Prospective cross-sectional study of adults reporting neck/shoulder pain and pain-free individuals.
SETTING: Participants were recruited from the community and assessed in a research laboratory.
PARTICIPANTS: Of the N=96 adults recruited for the study, 84 had complete records (mean age±SD, 32.7±13.2 y; 58.3% women). On physical examination, they were classified into an active group (those with spontaneous MP without provocation, n=25), a latent group (those with MP upon provocation, n=38), or a referent group (those with no MP in the neck and shoulder, n=21).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Pain intensity and interference; symptom burden measured using patient-reported outcomes and objective measures: Pain Catastrophizing Scale (PCS); Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function; sleep disturbance; anxiety; depression; hypermobility (Beighton/Brighton); objective measures in the medial upper trapezius using pressure pain threshold and quantitative sensory testing.
RESULTS: The symptom burden explained 75% of the variance in pain intensity and interference in the overall sample, 82% in the active group, and 92% in the referent group. PROMIS Physical Function and PCS were key predictors of pain intensity and interference. Network analysis identified unique symptom clusters in the active and latent groups.
CONCLUSIONS: Multidimensional symptom burden explains the variability in the clinical spectrum of pain intensity and interference in unexplained neck/shoulder MP. Network analysis can further improve clinical risk stratification. These findings represent a step toward the eventual goal of developing multidisciplinary clinical guidance for managing the whole patient, rather than the current emphasis on regional contributors to MP.