title: Central Pain Processing in Patients with Shoulder Pain: A Review of the Literature.
abstract: Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients.
  
  
  
  The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies.
  
  
  
  Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particular, quantitative sensory testing revealed hyperalgesia for pressure pain in the MSK group, whereas these results were inconsistent in patients with HSP. Conditioned pain modulation was reduced in patients with MSK shoulder pain, but functioned normally in the HSP group.
  
  
  
  This review has shown that great progress has been made toward a better understanding of neurophysiologic pain mechanisms in patients with shoulder pain. The presence of generalized mechanical hyperalgesia, allodynia, and impaired conditioned pain modulation in patients with MSK shoulder pain indicates the involvement of the central nervous system. Widespread somatosensory abnormalities observed in patients with HSP could suggest a central origin for their shoulder pain and predispose patients with HSP to develop CS, although results are inconsistent. Additional research is required adopting different assessment methods (especially dynamic methods) to establish the role of CS in patients with shoulder pain.
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain.|Pain in Motion International Research Group, Antwerp, Belgium.
authors.forename: Suzie
authors.initials: S
authors.lastname: Noten
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain.
authors.forename: Filip
authors.initials: F
authors.lastname: Struyf
authors.affiliation: Pain in Motion International Research Group, Antwerp, Belgium.|Department of Physical Therapy, University of Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Lluch
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain.
authors.forename: Marika
authors.initials: M
authors.lastname: D'Hoore
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain.
authors.forename: Eveline
authors.initials: E
authors.lastname: Van Looveren
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Spain.|Pain in Motion International Research Group, Antwerp, Belgium.|Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Mira
authors.initials: M
authors.lastname: Meeus
mesh_terms: D059333:Central Nervous System Sensitization / Q000502:physiology; D005260:Female; D006801:Humans; D006930:Hyperalgesia; D008297:Male; D059352:Musculoskeletal Pain; D011312:Pressure; D020069:Shoulder Pain / Q000503:physiopathology* / Q000523:psychology*
keywords: central sensitization; chronic pain; pain processing; shoulder; systematic review