257: What We Know About Psychosocial Factors in Shoulder Pain May Be Biased by Research Context: A Review

Topic: Clinical Science
Subtopic:

Background and Aims: Shoulder pain is a debilitating condition that affects people across diverse demographic contexts. Psychosocial factors influence pain and disability outcomes; however, it remains unclear whether evidence represents different countries’ income levels and racial/ethnic groups. Socioeconomic status, race, and ethnicity shape experiences of pain and access to care, suggesting that research context may influence the observed psychosocial-pain relationship. A lack of equality, diversity, and inclusivity in shoulder pain research limits the applicability of current evidence to underserved populations. Our scoping review mapped the distribution of studies on psychosocial factors in shoulder pain across country income levels and racial/ethnic representation

Methods: We searched 10 databases. Primary studies that addressed any psychosocial domains in adults with shoulder pain were included. Studies that targeted shoulder fracture, adhesive capsulitis, or shoulder disorders secondary to other pathologies (e.g., breast cancer, stroke) were excluded. We extracted the study and participants’ sociodemographic data.

Results: 6081 articles were identified, and 255 were included. The sample consisted of 1,343,509 individuals (45,8% female, mean age: 50.3±9.8 years). These studies were carried out in high- (82.4%), middle- (16.8%), and low- (0.8%) income countries. Most studies (n = 213, 83.5%) did not report participant race. Among those studies that reported race (n = 42), White race was included in 42 studies, Black or African American in 35, Asian in 16, Hispanic or Latino in 7, Native Hawaiian or another Pacific Islander in 5, and American Indian or Alaska Native in 4.

Conclusions: Prior research on shoulder pain investigating the impact of psychosocial factors is largely derived from high-income countries. There is limited evidence from middle- and low-income settings and poor reporting of participants’ race/ethnicity. This imbalance suggests that the current understanding of the relationship between shoulder pain and psychosocial factors may be shaped by the research context and may not generalize adequately across populations with different socioeconomic and demographic statuses. Psychosocial models are based mainly on evidence from high-income countries. Improving representation across country income levels and strengthening sociodemographic reporting are essential to enhance the applicability of context-sensitive clinical practice.

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Presenting Author: Lucas Almeida
Submitting Author: Lucas Almeida

Senior Author: Federico Pozzi

IASP 2026 Global Year theme of Neuropathic Pain: No

• Lucas Almeida - University of Florida
• Dalton Whitman - University of Florida
• Jane Morgan-Daniel - University of Florida
• Bruno Mazuquin - Manchester Metropolitan University
• Jason Beneciuk - University of Florida
• Federico Pozzi - University of Florida