The impact of central sensitization-related symptoms on subacromial steroid injection outcomes in patients with subacromial impingement syndrome: an observational study
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Background: Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome(SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CSrelatedsymptoms. Methods: Patients who received subacromial steroid injection were evaluated before the injection, at the first andthird months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and painhypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analogscale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and ShortForm-36. Results: With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups,VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability,anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreasedsignificantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although bothgroups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showeda notable PPT decline at the first month (P < 0.05). Conclusions: Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroidinjections.
Abstract
Background: Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome(SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CSrelatedsymptoms. Methods: Patients who received subacromial steroid injection were evaluated before the injection, at the first andthird months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and painhypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analogscale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and ShortForm-36. Results: With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups,VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability,anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreasedsignificantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although bothgroups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showeda notable PPT decline at the first month (P < 0.05). Conclusions: Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroidinjections.