Abstract
Shoulder pain is a common musculoskeletal complaint associated with a significant impact on health and socioeconomic outcomes. Current evidence indicates a poor understanding of the mechanisms driving shoulder pain experience. The heightened nociceptive processing (pro-nociceptive pain modulation profile) within the central nervous system could explain variability in the shoulder pain experience. This topical review and hypothesis-generating paper discuss the current evidence and gaps regarding abnormal nociceptive processing in patients with shoulder pain. This paper also proposes hypotheses to test the presence of a pro-nociceptive pain modulation profile by measuring the pain responses to conditioned pain modulation, mechanical temporal summation and movement-evoked pain procedures. Moreover, this paper proposes whether a pro-nociceptive pain modulation profile can explain the variability in the pain experience in people with shoulder pain. Gaining insights into the abnormal nociceptive processing in people with acute and chronic shoulder pain will guide future research and clinical practice to improve shoulder pain outcomes.