Dealing with complexity in decision-making for chronic shoulder pain: a pragmatic approach for individual phenotyping

Chronic shoulder pain (CSP) is a common musculoskeletal pain condition. However, predominant decision-making follows a biomedical model that does not reflect the complexity and individuality of CSP's clinical presentation. Considering that a multidimensional assessment of CSP might be challenging for clinicians, this review aimed to identify phenotypic domains that should be considered in the onset and persistence of shoulder pain. Furthermore, we propose integrating individual phenotyping into pragmatic decision-making for CSP.

This review followed a systematic narrative hybrid literature review methodology. A literature search was conducted in PubMed, Web of Science, and EBSCO, focusing on core domains for individual phenotyping in shoulder pain or chronic musculoskeletal pain.

Our search yielded 593,172 hits. After removing duplicate results, screening, and analysing the findings, 9 previous studies reporting phenotypic domains were included. A novel pragmatic phenotyping approach for CSP was presented, which includes five phenotypic domains: reported pain, pathobiological manifestations, disability/functioning, psychological and contextual domains. A seven-step decision-making process is encouraged: (1) interview, (2) red flag triage, (3) physical examination, (4) behavioural assessment, (5) differential diagnosis, (6) complementary diagnostic tests, and (7) individual phenotyping.

This pragmatic approach provides a promising roadmap to guide clinical decision-making towards person-centred care for the complex problem of CSP.