Neuroticism, extraversion, anxiety and type a behaviour as mediators of neck, shoulder and lower back pain in female hospital staff

The Unhappy Shoulder: A Conceptual Review of the Psychosomatics of Shoulder Pain

INTRODUCTION

Chronic pain is a multifaceted disorder genuinely entangled with psychic and psychosomatic symptoms, which are typically involved in the processes of chronification. The impingement syndrome of the shoulder is no exception to this rule, but several studies have shown respective peculiarities among those with pain and impingement of the shoulder. Notably, chronic pain is a lateralized experience, and, similarly, its psychosomatic correlates may be attached to the hemispheres functionally.

AIM

The present review therefore gives an overview of the respective findings, with regard not only to psychopathology, but also to personality factors and psychologic trauma, since the latter are reportedly associated with chronic pain. Moreover, we acknowledge symmetry as a possible pathogenic factor.

METHODS

This narrative review followed the current standards for conducting narrative studies. Based on prior findings, our research strategy included the relevance of psychotraumatologic and symmetrical aspects, as well as comorbidity. We retrieved the relevant literature reporting on the impact of psychopathology as well as personality features on shoulder pain, as published up to January 2022 from the Medline database (1966-2022). Study selecton: We included numerous studies, and considered the contextual relevance of studies referring to the neuropsychosomatics of chronic pain.

RESULTS

Pain-specific fears, depression, and anxiety are important predictors of shoulder pain, and the latter is generally overrepresented in those with trauma and PTSD. Moreover, associations of shoulder pain with psychological variables are stronger as regards surgical therapies as compared to conservative ones. This may point to a specific and possibly trauma-related vulnerability for perioperative maladaptation. Additionally, functional hemispheric lateralization may explain some of those results given that limb pain is a naturally lateralized experience. Not least, psychosocial risk factors are shared between shoulder pain and its physical comorbidities (e.g., hypertension), and the incapacitated state of the shoulder is a massive threat to the function of the human body as a whole.

CONCLUSIONS

This review suggests the involvement of psychosomatic and psychotraumatologic factors in shoulder impingement-related chronic pain, but the inconclusiveness and heterogeneity of the literature in the field is possibly suggestive of other determinants such as laterality.

Genetic correlations between pain phenotypes and depression and neuroticism

Correlations between pain phenotypes and psychiatric traits such as depression and the personality trait of neuroticism are not fully understood. In this study, we estimated the genetic correlations of eight pain phenotypes (defined by the UK Biobank, n = 151,922–226,683) with depressive symptoms, major depressive disorders and neuroticism using the the cross-trait linkage disequilibrium score regression (LDSC) method integrated in the LD Hub. We also used the LDSC software to calculate the genetic correlations among pain phenotypes. All pain phenotypes, except hip pain and knee pain, had significant and positive genetic correlations with depressive symptoms, major depressive disorders and neuroticism. All pain phenotypes were heritable, with pain all over the body showing the highest heritability (h² = 0.31, standard error = 0.072). Many pain phenotypes had positive and significant genetic correlations with each other indicating shared genetic mechanisms. Our results suggest that pain, neuroticism and depression share partially overlapping genetic risk factors.

Sensory Processing Sensitivity

The aim of the present study was to examine the factor structure of a Norwegian version of the Highly Sensitive Person Scale (HSPS) and to investigate how sensory processing sensitivity (SPS) is related to personality traits of neuroticism, extraversion, and openness and to subjective health complaints (SHC) in a sample of 167 undergraduate psychology students. The results showed that the variance in a shortened version of the HSPS was best described by three separate factors: ease of excitation (EOE), aesthetic sensitivity (AES), and low sensory threshold (LST). Furthermore, the result showed than an overall SPS factor (EOE, LST, and AES combined) was predicted positively by neuroticism and openness and negatively by extraversion. With respect to SHC, the results showed that EOE and LST were positively associated with psychological health complaints. However, the personality trait of neuroticism contributed more than the SPS factors as predictor of SHC. In conclusion, the present study supported a shortened version of the HSPS and its relation to personality factors and SHC.

A scoring system for subjective health complaints (SHC)

The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (α=0.74), pseudoneurology (α=0.73), gastrointestinal problems (α=0.62), allergy (α=0.58) and flu (α=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.

Sensory Processing Sensitivity

The aim of the present study was to examine the factor structure of a Norwegian version of the Highly Sensitive Person Scale (HSPS) and to investigate how sensory processing sensitivity (SPS) is related to personality traits of neuroticism, extraversion, and openness and to subjective health complaints (SHC) in a sample of 167 undergraduate psychology students. The results showed that the variance in a shortened version of the HSPS was best described by three separate factors: ease of excitation (EOE), aesthetic sensitivity (AES), and low sensory threshold (LST). Furthermore, the result showed than an overall SPS factor (EOE, LST, and AES combined) was predicted positively by neuroticism and openness and negatively by extraversion. With respect to SHC, the results showed that EOE and LST were positively associated with psychological health complaints. However, the personality trait of neuroticism contributed more than the SPS factors as predictor of SHC. In conclusion, the present study supported a shortened version of the HSPS and its relation to personality factors and SHC.

Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences

BACKGROUND

Given a worldwide shortage of primary health care workers predicted to worsen, it is vital to address sources of attrition among these professionals. One such source may be work-related musculoskeletal disorders. We aimed to identify risk factors for and functional consequences of work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians.

METHODS

Eighteen of 87 studies identified from an electronic database search met the inclusion and quality criteria.

RESULTS

Job demands, demanding work schedules and physical exposures have the strongest associations with work-related upper quadrant musculoskeletal disorders. Functional consequences included widespread use of prescription and over-the-counter medications and major negative impact on activities of daily living. No studies of midwives were located.

CONCLUSION

High-quality studies of midwives as well as better-designed prospective studies of nurses and physicians are needed. Results of such studies could inform preventive strategies and reduce the contribution of work-related musculoskeletal disorders to attrition.

Neck and shoulder pain related to computer use

The neck and shoulder pain (NSP) symptoms are very common among intensive computer users. This paper reviews recent 20 years' research publications, which have focused on pathophysiology and other aspects of the neck and shoulder pain related to computer use (NSPRCU). The disorder is usually multidimensional, occupational, personal and social factors are among these evolved. Suggestions concerning the diagnostics, procedures of prevention, and treatment options have been discussed. As the details of pathophysiology of these disorders are not yet clear, further studies on NSPRCU are necessary.

Personality traits predict self-referral of young male adults with musculoskeletal complaints to a general practitioner

OBJECTIVE

To investigate the effects of personality traits on self-referral to a general practitioner (GP).

METHODS

217 male soldiers who underwent advanced training course filled the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Perceived Stress Scale and were followed up for a period of 14 weeks. Every soldier who self-referred to the clinic was physically examined by a GP. The major complaint and the GP's diagnosis were documented.

RESULTS

106 of the 217 soldiers self-referred. Self-referred soldiers had significantly (P=.02) higher levels of extraversion than soldiers who did not. Specifically, higher levels of extraversion were evident among soldiers who self-referred with musculoskeletal complaints (P<.05). No significant difference in stress levels was found between soldiers who self-referred and those who did not.

CONCLUSIONS

These findings underscore the association between extraversion and musculoskeletal complaints among young adult males and suggest that psychological variables should be taken under consideration in the prevention and treatment of orthopedic problems.

Low intensity pain reported during elicitation of the H-reflex: no effects of trait anxiety and high intensity cycling exercise

The aims of the experiment were to describe the intensity of pain perceptions experienced in response to elicitation of the H-reflex and examine the roles of trait anxiety and high intensity cycling exercise on those pain responses. Males (n=24) with high (n=12) or low (n=12) trait anxiety provided ratings of pain intensity in response to elicitation of the H-reflex before and after: resting for 20 min, cycling for 20 min at a high intensity (75% of peak oxygen consumption), or cycling for 20 min at a low intensity (40% of peak oxygen consumption). The results indicated that (i). low intensity pain was experienced during the elicitation of the H-reflex; (ii). high trait anxious males did not report more pain during the elicitation of the H-reflex, and (iii). there was no effect of high intensity cycling exercise on reducing post-exercise pain intensity associated with H-reflex elicitation. It is concluded that elicitation of the H-reflex reliably results in a low intensity pain.

Can stress-related shoulder and neck pain develop independently of muscle activity?

A case-control designed was used to investigate associations and interactions between muscle activity measured by surface electromyography (EMG) in the upper trapezius muscle and subjectively reported risk factors in workers with and without shoulder and neck pain. EMG data were collected both in the workplace (indicating vocational muscle activity) and in a laboratory setting (indicating non-specific muscle activity). Women in manual (15 pairs) and office (24 pairs) work were included. The pairs were matched on age, gender and on current and historical work load, such as working hours, type and length of employment. Previous reports of this study have indicated that shoulder and neck myalgia was associated with increased muscle activity for the manual workers, and with psychological and psychosocial factors for the office workers. These risk factors were in the present report used as the basis for studying associations and interactions between muscle activity (1), psychological and psychosocial factors (2), and shoulder and neck pain (3). Subjectively reported or perceived general tension, a stress symptom presumed related to psychosocial and psychological factors, was previously found to be the strongest and only variable separating cases and controls in both work groups. In this paper, no relationship was found between perceived general tension and EMG variables for the office workers. For the manual workers a strong interaction was found; perceived general tension correlated positively with EMG variables for the controls, and negatively with EMG variables for the cases. It is hypothesised that the feeling of general tension represents a physiological activation response that may or may not include muscle fibre activation. This implies that pain provoked by psychosocial stress factors may not be mediated through increased muscle activity.

A case-control study of psychological and psychosocial risk factors for shoulder and neck pain at the workplace

Risk factors associated with work-related shoulder and neck myalgia were investigated in a case-control study with pairs matched for age, gender, and physical exposure. Guided interviews with standardized and self-constructed questionnaires were performed among manual (n = 15 pairs) and office (n = 24 pairs) workers. Perceived general tension was the variable with the strongest association with shoulder and neck pain in both work groups. Otherwise, the results in the two groups were very different, indicating that different risk factors and mechanisms were associated with shoulder and neck pain in the two work groups. The study provides background information for future attempts to establish causal relationships between physical and psychosocial exposure and shoulder and neck pain, which can be more accurately investigated in a longitudinal rather than a cross-sectional experimental design.

Psychophysiological stress and emg activity of the trapezius muscle

Although it is generally assumed that mental stress induces muscular tension, the experimental data have, so far, been inconclusive. Likely explanations for these inconsistent findings are (a) too small subject samples in some experiments, (b) the use of only one type of stress stimulation, and (c) the lack of objective (physiological) measurements documenting the stress-inducing properties of the experimental treatment. Furthermore. the effect of mental stress and physical load separately, versus the combined influence of physical and mental load on muscular tension, has not been investigated earlier. Therefore, the aim o f the present experiment was lo examine the effects of mental stress as well as of physical load, separately and in combination, on perceived stress, physiological stress responses, and on muscular tension as reflected in electromyographical (EMG) activity of the trapezius muscle. Sixty two female subjects were individually exposed to mental arithmetic, the Stroop color word test (CWT), the cold pressor test, standardized test contractions (TCs), and the CWT combined with a TC. Compared to baseline, the stress session induced significant increases in systolic and diastolic blood pressure, heart rate, urinary catecholamines, salivary cortisol, and self-reported stress. Each of the two mental stress tests induced a significant increase in EMG activity. The CWT caused a rise in EMG activity also during the TC, which was significantly more pronounced than the increase induced by the CWT alone. Blood pressure responses and self-reported stress followed the same pattern as the EMG activity. The results are consistent with the assumption that psychological stress plays a role in musculoskeletal disorders by increasing muscular tension both in low-load work situations and in the absence of physical load. It is also indicated that the stress-induced increase in muscular tension is accentuated on top of a physical load.