title: Chronic shoulder pain in the community: a syndrome of disability or distress?
abstract: OBJECTIVE
  To investigate two questions in a community based population of people with chronic shoulder pain. Firstly, does chronic pain lead to impaired psychological health over time? Secondly, how does restriction of daily activity influence pain perception and psychological health?
  
  
  METHODS
  Two postal surveys, two years apart, were carried out to identify a group of subjects with chronic shoulder pain. The first survey was sent to a random sample of adults (n=40026) registered with a primary care practice, and included a pain manikin, demographic information, and the Hospital Anxiety and Depression scale (HAD). The second survey was sent to those subjects who reported unilateral shoulder region pain in the first survey and it included a shoulder-specific disability scale, pain severity score, and the HAD.
  
  
  RESULTS
  2606 (65.1%) people responded to the initial survey. Of these, 304 (11.7%) reported unilateral shoulder region pain at baseline. In the subsequent survey, there were 234 responders (83.3% adjusted response): 142 of these reported shoulder pain and formed our study group of "subjects with chronic shoulder pain". Within this group there was no significant change in psychological distress scores between baseline and follow up. Both the disability score and psychological distress scores correlated significantly with pain severity (disability v pain r=0.536, p<0.001; psychological distress v pain r=0.269, p=0.002). When the correlation between disability and pain severity was corrected for possible confounders, it remained significant (r=0.490, p<0.001). This was not the case for the correlation between psychological distress and pain (p>0.05). Disability was significantly correlated with psychological distress on univariate (r=0.445, p<0.001) and multivariate analysis (r=0.341, p=0.002).
  
  
  CONCLUSIONS
  In those with chronic shoulder pain the relation between pain and psychological health seems to be linked to disability. Psychological distress was not explained by persistent pain itself.
authors.affiliation: Staffordshire Rheumatology Centre, Haywood Hospital, Stoke on Trent, UK.
authors.forename: L J
authors.initials: LJ
authors.lastname: Badcock
authors.forename: M
authors.initials: M
authors.lastname: Lewis
authors.forename: E M
authors.initials: EM
authors.lastname: Hay
authors.forename: R
authors.initials: R
authors.lastname: McCarney
authors.forename: P R
authors.initials: PR
authors.lastname: Croft
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D020069:Shoulder Pain / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology