{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:26:17Z","timestamp":1789500377141,"version":"build-2803163510"},"reference-count":53,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Frozen shoulder (FS) is a poorly understood condition resulting in substantial shoulder pain and mobility deficits. The mechanisms behind FS are not yet fully understood, but, similar to other persistent pain states, central pain mechanisms may contribute to ongoing symptoms in this population. The objective of this research was to investigate conditioned pain modulation (CPM) in people with FS compared with pain-free individuals. A total of 64 individuals with FS and 64 healthy volunteers participated in this cross-sectional study. CPM was assessed by using the pressure pain threshold (PPT) and an occlusion cuff (tourniquet test) as the test and conditioning stimulus, respectively. The absolute and percentage of change in PPT (CPM effect) as well as pain profiles (pro-nociceptive vs. anti-nociceptive) of individuals with FS and healthy controls were calculated. No significant differences in the absolute change in the PPT or CPM effect were found in people with FS compared to pain-free controls. Moreover, no between-group differences in the percentage of subjects with pro-nociceptive and anti-nociceptive pain profiles were observed. These results suggest that endogenous pain inhibition is normally functioning in people with FS. Altered central pain-processing mechanisms may thus not be a characteristic of this population.<\/jats:p>","DOI":"10.3390\/ijerph182312330","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T05:23:02Z","timestamp":1638163382000},"page":"12330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Conditioned Pain Modulation Is Not Impaired in Individuals with Frozen Shoulder: A Case-Control Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5541-0662","authenticated-orcid":false,"given":"Marta","family":"Aguilar-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8592-1738","authenticated-orcid":false,"given":"Lirios","family":"Due\u00f1as","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"},{"name":"Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0216-0628","authenticated-orcid":false,"given":"Merc\u00e8","family":"Balasch i Bernat","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"},{"name":"Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Meeus","sequence":"additional","affiliation":[{"name":"Pain in Motion International Research Group, 2000 Antwerp, Belgium"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Struyf","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Lluch","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"},{"name":"Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain"},{"name":"Pain in Motion International Research Group, 2000 Antwerp, Belgium"},{"name":"Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2013.0302","article-title":"Shoulder Pain and Mobility Deficits: Adhesive Capsulitis","volume":"43","author":"Kelley","year":"2013","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1177\/0363546509348048","article-title":"Adhesive Capsulitis: A Review of Current Treatment","volume":"38","author":"Neviaser","year":"2010","journal-title":"Am. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/JSA.0b013e3181595c22","article-title":"Adhesive Capsulitis","volume":"15","author":"Tasto","year":"2007","journal-title":"Sports Med. Arthrosc. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0306-4522(03)00337-3","article-title":"A Role for Peripheral Somatostatin Receptors in Counter-Irritation-Induced Analgesia","volume":"120","author":"Carlton","year":"2003","journal-title":"Neuroscience"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/j.1526-4610.2009.01545.x","article-title":"Noxious Inhibition of Temporal Summation Is Impaired in Chronic Tension-Type Headache","volume":"50","author":"Cathcart","year":"2010","journal-title":"Headache"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Akbar, M., McLean, M., Garcia-Melchor, E., Crowe, L.A., McMillan, P., Fazzi, U.G., Martin, D., Arthur, A., Reilly, J.H., and McInnes, I.B. (2019). Fibroblast Activation and Inflammation in Frozen Shoulder. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215301"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1080\/03008207.2019.1648445","article-title":"Biomarkers Associated with Idiopathic Frozen Shoulder: A Systematic Review","volume":"61","author":"Andronic","year":"2020","journal-title":"Connect. Tissue Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/s13018-016-0493-8","article-title":"Characterization of a Frozen Shoulder Model Using Immobilization in Rats","volume":"11","author":"Kim","year":"2016","journal-title":"J. Orthop. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1302\/0301-620X.89B7.19097","article-title":"The Pathology of Frozen Shoulder","volume":"89-B","author":"Hand","year":"2007","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1053\/apmr.2002.32472","article-title":"Suprascapular Nerve Block for Pain Relief in Adhesive Capsulitis: Comparison of 2 Different Techniques","volume":"83","author":"Meray","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.apmr.2020.11.003","article-title":"Proximal vs Distal Approach of Ultrasound-Guided Suprascapular Nerve Block for Patients With Adhesive Capsulitis of the Shoulder: Prospective Randomized Controlled Trial","volume":"102","author":"Bae","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1136\/bjsports-2012-091492","article-title":"Why Does My Shoulder Hurt? A Review of the Neuroanatomical and Biochemical Basis of Shoulder Pain","volume":"47","author":"Dean","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"ref_13","first-page":"539","article-title":"Clinical Effectiveness of Non-Surgical Interventions for Primary Frozen Shoulder: A Systematic Review","volume":"51","author":"Lowe","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1177\/1758573216676786","article-title":"Adhesive Capsulitis of the Shoulder: Review of Pathophysiology and Current Clinical Treatments","volume":"9","author":"Le","year":"2017","journal-title":"Shoulder Elb."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.msksp.2018.07.001","article-title":"Does Muscle Guarding Play a Role in Range of Motion Loss in Patients with Frozen Shoulder?","volume":"37","author":"Hollmann","year":"2018","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1007\/s10067-013-2464-3","article-title":"Current Evidence on Physical Therapy in Patients with Adhesive Capsulitis: What Are We Missing?","volume":"33","author":"Struyf","year":"2014","journal-title":"Clin. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102136","DOI":"10.1016\/j.msksp.2020.102136","article-title":"Laterality Judgement and Tactile Acuity in Patients with Frozen Shoulder: A Cross-Sectional Study","volume":"47","author":"Reis","year":"2020","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Breckenridge, J.D., McAuley, J.H., and Ginn, K.A. (2020). Motor Imagery Performance and Tactile Spatial Acuity: Are They Altered in People with Frozen Shoulder?. Int. J. Environ. Res. Public. Health, 17.","DOI":"10.3390\/ijerph17207464"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1016\/j.apmr.2017.03.031","article-title":"Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion","volume":"98","author":"Louw","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1111\/sms.12982","article-title":"Sensory Processing and Central Pain Modulation in Patients with Chronic Shoulder Pain: A Case-Control Study","volume":"28","author":"Kuppens","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.msksp.2018.11.008","article-title":"People with Musculoskeletal Shoulder Pain Demonstrate No Signs of Altered Pain Processing","volume":"39","author":"Haik","year":"2019","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/ejp.1140","article-title":"Assessment and Manifestation of Central Sensitisation across Different Chronic Pain Conditions","volume":"22","author":"Morlion","year":"2018","journal-title":"Eur. J. Pain Lond. Engl."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1097\/j.pain.0000000000001664","article-title":"Conditioned Pain Modulation as Biomarker of Chronic Pain: A Systematic Review of Its Concurrent Validity","volume":"160","author":"Fernandes","year":"2019","journal-title":"Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/0304-3959(79)90049-6","article-title":"Diffuse Noxious Inhibitory Controls (DNIC). I. Effects on Dorsal Horn Convergent Neurones in the Rat","volume":"6","author":"Dickenson","year":"1979","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ejpain.2010.02.004","article-title":"Recommendations on Terminology and Practice of Psychophysical DNIC Testing","volume":"14","author":"Yarnitsky","year":"2010","journal-title":"Eur. J. Pain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S24","DOI":"10.1097\/01.j.pain.0000460343.46847.58","article-title":"Role of Endogenous Pain Modulation in Chronic Pain Mechanisms and Treatment","volume":"156","author":"Yarnitsky","year":"2015","journal-title":"Pain"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/j.pain.0000000000002019","article-title":"The Predictive Value of Quantitative Sensory Testing: A Systematic Review on Chronic Postoperative Pain and the Analgesic Effect of Pharmacological Therapies in Patients with Chronic Pain","volume":"162","author":"Petersen","year":"2021","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1097\/j.pain.0000000000001590","article-title":"Quantitative Sensory Testing and Predicting Outcomes for Musculoskeletal Pain, Disability, and Negative Affect: A Systematic Review and Meta-Analysis","volume":"160","author":"Georgopoulos","year":"2019","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.jpain.2012.07.005","article-title":"Conditioned Pain Modulation in Populations with Chronic Pain: A Systematic Review and Meta-Analysis","volume":"13","author":"Lewis","year":"2012","journal-title":"J. Pain Off. J. Am. Pain Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e592","DOI":"10.1097\/PR9.0000000000000592","article-title":"Efficient Conditioned Pain Modulation despite Pain Persistence in Painful Diabetic Neuropathy","volume":"2","author":"Granovsky","year":"2017","journal-title":"PAIN Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.jpain.2014.09.001","article-title":"Analysis of Meaningful Conditioned Pain Modulation Effect in a Pain-Free Adult Population","volume":"15","author":"Locke","year":"2014","journal-title":"J. Pain Off. J. Am. Pain Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/SPC.0000000000000419","article-title":"Assessment of Conditioned Pain Modulation in Healthy Participants and Patients with Chronic Pain: Manifestations and Implications for Pain Progression","volume":"13","author":"Petersen","year":"2019","journal-title":"Curr. Opin. Support. Palliat. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/EDE.0b013e3181577654","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"18","author":"Altman","year":"2007","journal-title":"Epidemiology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.11124\/JBISRIR-2017-003402","article-title":"Laterality Judgment Performance between People with Chronic Pain and Pain-Free Individuals: A Systematic Review Protocol","volume":"16","author":"Ravat","year":"2018","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1111\/j.1553-2712.2001.tb01132.x","article-title":"Reliability of the Visual Analog Scale for Measurement of Acute Pain","volume":"8","author":"Bijur","year":"2001","journal-title":"Acad. Emerg. Med. Off. J. Soc. Acad. Emerg. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.pain.2003.05.001","article-title":"Evidence for Spinal Cord Hypersensitivity in Chronic Pain after Whiplash Injury and in Fibromyalgia","volume":"107","author":"Banic","year":"2004","journal-title":"Pain"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.pain.2004.12.003","article-title":"Sensory and Motor Effects of Experimental Muscle Pain in Patients with Lateral Epicondylalgia and Controls with Delayed Onset Muscle Soreness","volume":"114","author":"Slater","year":"2005","journal-title":"Pain"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.math.2009.07.002","article-title":"Exercise-Induced Mechanical Hypoalgesia in Musculotendinous Tissues of the Lateral Elbow","volume":"15","author":"Slater","year":"2010","journal-title":"Man. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.ejpain.2005.07.002","article-title":"Heterotopic Ischemic Pain Attenuates Somatosensory Evoked Potentials Induced by Electrical Tooth Stimulation: Diffuse Noxious Inhibitory Controls in the Trigeminal Nerve Territory","volume":"10","author":"Fujii","year":"2006","journal-title":"Eur. J. Pain Lond. Engl."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1155\/2009\/523098","article-title":"Reliability of Temporal Summation and Diffuse Noxious Inhibitory Control","volume":"14","author":"Cathcart","year":"2009","journal-title":"Pain Res. Manag."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1097\/j.pain.0000000000000689","article-title":"Reliability of Conditioned Pain Modulation: A Systematic Review","volume":"157","author":"Kennedy","year":"2016","journal-title":"Pain"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.pain.2013.11.005","article-title":"Pain Modulation Profile and Pain Therapy: Between pro- and Antinociception","volume":"155","author":"Yarnitsky","year":"2014","journal-title":"Pain"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Valencia, C., Kindler, L.L., Fillingim, R.B., and George, S.Z. (2013). Stability of Conditioned Pain Modulation in Two Musculoskeletal Pain Models: Investigating the Influence of Shoulder Pain Intensity and Gender. BMC Musculoskelet. Disord., 14.","DOI":"10.1186\/1471-2474-14-182"},{"key":"ref_44","first-page":"521","article-title":"CPM Test-Retest Reliability: \u201cStandard\u201d vs. \u201cSingle Test-Stimulus\u201d Protocols","volume":"17","author":"Granovsky","year":"2016","journal-title":"Pain Med. Malden Mass"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/joor.12745","article-title":"Endogenous Pain Modulation in Chronic Temporomandibular Disorders: Derivation of Pain Modulation Profiles and Assessment of Its Relationship with Clinical Characteristics","volume":"46","year":"2019","journal-title":"J. Oral Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1002\/ejp.605","article-title":"Recommendations on Practice of Conditioned Pain Modulation (CPM) Testing","volume":"19","author":"Yarnitsky","year":"2015","journal-title":"Eur. J. Pain Lond. Engl."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1515\/sjpain-2018-0087","article-title":"Assessment of CPM Reliability: Quantification of the within-Subject Reliability of 10 Different Protocols","volume":"18","author":"Vaegter","year":"2018","journal-title":"Scand. J. Pain"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/papr.12305","article-title":"Inventory of Personal Factors Influencing Conditioned Pain Modulation in Healthy People: A Systematic Literature Review","volume":"16","author":"Hermans","year":"2016","journal-title":"Pain Pract."},{"key":"ref_49","first-page":"765","article-title":"Effect of Pain Induction or Pain Reduction on Conditioned Pain Modulation in Adults: A Systematic Review","volume":"15","author":"Goubert","year":"2015","journal-title":"Pain Pract. Off. J. World Inst. Pain"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1002\/j.1532-2149.2013.00332.x","article-title":"The Prevalence of Widespread Central Hypersensitivity in Chronic Pain Patients","volume":"17","author":"Schliessbach","year":"2013","journal-title":"Eur. J. Pain"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.rehab.2018.07.007","article-title":"Analgesic Gas for Rehabilitation of Frozen Shoulder: Protocol for a Randomized Controlled Trial","volume":"62","author":"Dupeyron","year":"2019","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.jse.2004.03.002","article-title":"Gentle Thawing of the Frozen Shoulder: A Prospective Study of Supervised Neglect versus Intensive Physical Therapy in Seventy-Seven Patients with Frozen Shoulder Syndrome Followed up for Two Years","volume":"13","author":"Diercks","year":"2004","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1097\/j.pain.0000000000001288","article-title":"Pain Sensitization Associated with Nonresponse after Physiotherapy in People with Knee Osteoarthritis","volume":"159","author":"Smart","year":"2018","journal-title":"Pain"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12330\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:34:59Z","timestamp":1760168099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":53,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182312330"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182312330","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]}}}