A prospective randomized pilot trial comparing two rehabilitation approaches for individuals with irritable shoulder pain

OBJECTIVES: Although irritability is traditionally theorized to reflect tissue damage, individuals with irritable shoulder pain may also have elevated pain sensitivity and negative psychological factors providing novel treatment targets. This pilot study aimed to evaluate the feasibility of a randomized controlled trial comparing a biomedical and biopsychosocial approach to treating irritable shoulder pain. A secondary aim was to report preliminary outcomes. METHODS: = 10). Participants completed eight intervention sessions over four weeks (2x/week), including exercise, stretching, and education based on their assigned group. Shoulder pain intensity on the 101-point Numeric Pain Rating Scale (NPRS), disability on the quickDASH, and psychological factors (pain catastrophizing, fear-avoidance beliefs, and anxiety) were measured at baseline and after the eighth session. RESULTS: The results of this study showed 100% treatment retention rates and 95% adherence rates with no adverse effects. The biopsychosocial group demonstrated greater mean improvements in shoulder pain (mean difference ± standard deviation = 28.80 ± 15.99) and disability (19.32 ± 11.25) compared to the biomedical group (pain: 5.67 ± 18.90, disability: 0.45 ± 8.62). For psychosocial factors, the biopsychosocial group showed notable decreases in pain catastrophizing (PCS: -8.50 ± 6.98), fear avoidance beliefs (FABQ-PA: -2.80 ± 5.92), and pain anxiety (PASS-20: -9.80 ± 12.74) when compared to the biomedical group who demonstrated very small increases (PCS: 0.70 ± 5.56, FABQ-PA: 0.10 ± 6.35, PASS-20: 1.40 ± 3.84). CONCLUSION: The protocols performed in this study displayed high feasibility providing support for this protocol potentially being implemented in larger randomized controlled trials. The biopsychosocial group demonstrated larger mean improvements in pain intensity, disability, and psychological factors compared to the biomedical group.