Biopsychosocial contributors to irritability in individuals with shoulder or low back pain

ABSTRACT

Objectives

Irritability is a foundational clinical reasoning concept in rehabilitation to evaluate reactivity of the examination and treatment. While originally theorized to reflect tissue damage, a large body of evidence supports pain is a biopsychosocial experience impacted by pain sensitivity and psychological factors. Therefore, the purpose of this study was to examine biopsychosocial contributors to irritability.

Methods

40 patients with shoulder (n = 20) and low back (n = 20) pain underwent Quantitative Sensory Testing (QST) (Pressure Pain Threshold, Heat Pain Threshold, Conditioned Pain Modulation, Temporal Summation), completed pain-related psychological questionnaires, an Exercise-Induced Hypoalgesia protocol, and standardized irritability assessment based on Clinical Practice Guidelines. Participants were then categorized as irritable or not irritable based on Maitland’s criteria and by irritability level based on Clinical Practice Guidelines. An independent samples t-test examined for differences in QST and psychological factors by irritability category. A MANOVA examined for differences in QST and psychological factors by irritability level (high, moderate, low).

Results

Significantly lower heat and pressure pain thresholds at multiple locations (p < 0.05), as well as less efficient conditioned pain modulation (p = 0.02), were demonstrated in individuals categorized as irritable. Heat and pressure pain thresholds were also significantly lower in patients with high irritability compared to other levels. Significantly higher depression and anger, as well as lower self-efficacy, were reported in individuals with an irritable presentation.

Discussion/Conclusion

Biopsychosocial factors, including widespread hyperalgesia and elevated psychological factors, may contribute to an irritable presentation.

KEYWORDS:

• Irritability
• Maitland
• shoulder pain
• low back pain
• evaluation
• SINSS
• quantitative sensory testing

Clinical trials registry

Not Applicable for this study – This is an observational study in which participants were not assigned interventions.

Data availability statement

Data set available upon request.

Disclosure statement

No potential conflict of interest was reported by the authors.

Institutional review board approval

This study was approved by the University of Central Florida Institutional Review Board for Human Subjects Research. All participants provided written informed consent to enroll in the study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2294679

Additional information

Funding

There is no funding to report.

Notes on contributors

Abigail T. Wilson

Abigail T. Wilson is an Assistant Professor in the Division of Physical Therapy at the University of Central Florida.

William J. Hanney

William J. Hanney is an Associate Professor in the Division of Physical Therapy at the University of Central Florida.

Randi M. Richardson

Randi Richardson is a Clinical Assistant Professor in the Division of Physical Therapy at the University of Central Florida.

Sheila H. Klausner

Sheila Klausner is a Clinical Assistant Professor in the Division of Physical Therapy at the University of Central Florida.

Joel E. Bialosky

Joel E. Bialosky is a Clinical Professor in the Department of Physical Therapy at the University of Florida.