Symptom burden explains most variance in pain intensity for unexplained myofascial neck/shoulder pain

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medRxiv Published April 4, 2026 Medically reviewed April 26, 2026 Study authors: Sikdar, S.; DeStefano, S.; Guzman Pavon, M. J.; Hsu, Y.-L.; Lee, S.; Srbely, J.; Shah, J.; Rosenberg… DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider assessing physical function and pain catastrophizing in unexplained myofascial pain, but note evidence is observational.

This prospective cross-sectional study analyzed 82 adults (mean age 32.2 years, 57% women) with complete records from 96 recruited individuals. Participants included 23 with active myofascial pain, 38 with latent myofascial pain, and 21 pain-free controls. The study assessed symptom burden using patient-reported outcomes (pain catastrophizing, physical function, sleep, anxiety, depression) and objective measures (pressure pain threshold, quantitative sensory testing).

Symptom burden explained 75% of the variance in pain intensity and interference (PEG) in the overall sample, 85% in the active group, and 92% in the normal group. Physical function and pain catastrophizing were identified as key predictors of pain intensity and interference. Network analysis revealed unique symptom clusters in the active and latent myofascial pain groups.

Safety and tolerability data were not reported. The study has several limitations: the cross-sectional design shows association only, not causation; no specific intervention was tested; the sample size was modest; and generalizability beyond the study population is unknown. Funding sources and conflicts of interest were not reported.

For clinical practice, these findings suggest that comprehensive assessment of symptom burden, particularly physical function and pain catastrophizing, may be relevant in evaluating patients with unexplained myofascial pain. The authors note network analysis could improve clinical risk stratification, representing a step toward developing multidisciplinary guidance. However, no treatment recommendations can be made from this observational data.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Objective: Myofascial pain (MP) is a leading cause of disability globally. Pain quality and severity vary widely for people with MP, making it difficult to accurately assess the spectrum of symptoms and develop appropriate treatments. We assessed potential contributors to variability in the clinical spectrum of unexplained neck/shoulder pain and associated myofascial component(s). Design: Prospective cross-sectional study of adults reporting neck/shoulder pain and pain-free individuals. Outcomes Measures: Pain intensity and interference (PEG); Symptom burden measured using patient-reported outcomes and objective measures: pain catastrophizing (PCS); PROMIS physical function (PF); sleep disturbance; anxiety (GAD-2); depression (PHQ-2); hypermobility (Beighton/Brighton); Objective measures in the medial upper trapezius: pressure pain threshold (PPT) and quantitative sensory testing (QST). Results: Of the 96 adults recruited for the study, 82 had complete records (age 32.2 +/-13.1 years, 57% women). On physical exam, 23 were assessed to be in an active group (those with spontaneous MP without provocation), 38 in a latent group (those with MP upon provocation), and 21 in a normal group (no MP in neck and shoulder). The symptom burden explained 75% of the variance in PEG in the overall sample, 85% in the active group and 92% in the normal group. PF and PCS are key predictors of PEG. Network analysis identified unique symptom clusters in the active and latent groups. Conclusions: The symptom burden explains the variability in the clinical spectrum of pain intensity and interference in unexplained neck/shoulder MP. Network analysis can further improve clinical risk stratification. These findings represent a step towards an eventual goal of developing multidisciplinary clinical guidance for managing the whole patient, rather than the current emphasis on regional pain contributors in MP.