Abnormal Pain Response After a Compensable Shoulder Injury

Area of Science:

• Occupational Health
• Psychosomatic Medicine
• Orthopedics

Background:

• Psychosocial factors are recognized in shoulder abnormalities.
• Prevalence of exaggerated pain behaviors in injured workers is understudied.

Purpose of the Study:

• Determine the prevalence of abnormal pain responses (APRs) in workers with shoulder injuries and active workers' compensation claims.
• Compare characteristics of workers with and without APRs.

Main Methods:

• Cross-sectional study analyzing electronic data of injured workers.
• APRs defined by exaggerated clinical pain responses (e.g., grimacing, withdrawal, nonanatomic signs).
• APR group (n=86) matched with control group (n=86) for sex, age, and surgical candidacy.

Main Results:

• 9% of injured workers (86/1000) exhibited APRs.
• No significant differences in wait time, injury mechanism, comorbidities, injury type, or medication.
• APR group showed higher disability (P < .0001), psychological problems (P < .0001), range of motion inconsistency (P = .04), and work limitations (P = .02).

Conclusions:

• Abnormal pain responses in workers with shoulder injuries correlate with increased disability and psychological distress.
• Patients with APRs are more likely to be absent from work and less likely to resume full duties.