Contralateral Treatment for Centrally Sensitized Chronic Shoulder Pain” A Case Report
Posted:Monday, August 4, 2014
Rosie Goldsmith, BA, LMT, DAFNS
Background and Objectives: Severe chronic pain affects up to 100 million Americans. Central sensitization (CS) of pain is where there is an increased pain responsiveness of the central nervous system to slightest touch or movement. Acute musculoskeletal injury induced pain may develop into CS pain. Contralateral manual therapy and exercise of the opposite arm has been shown to stimulate muscles and pain signaling of an affected limb. This case report investigates whether contralateral inhibitory exercise techniques can be effective to treat a patient with central sensitization of chronic shoulder pain.
Methods: The patient, a 45 year old man with a history of 3 years post-injury severe chronic right shoulder pain, showed all the signs of central sensitization. He was assessed for range of motion and pain. His pain contraindicated direct touch. Over a course of 12 sessions spanning 24 weeks, Visual Analogue Scales were used for pain, and the patient kept a log of the use of his need to wear a transcutaneous electrical nerve stimulation (TENS) unit to interrupt the pain signaling. Part way through the series practitioner obtained informed consent and recruited patient’s wife to assist with exercises at home. Practitioner lightly palpated to find the most painful sites on the right shoulder, then used slow resisted range of motion, or concentric isotonic contractions to homologous muscles and tendons of the left arm.
Results: Patient had a substantial reduction in pain, improvements in sleep and confidence. He was able to resume normal activities in his home and family, and return to work for the first time in three years.
Conclusion: This case report showed a beneficial effect of contralateral massage and exercise treatment for centrally sensitized pain. It merits further study under controlled conditions.