Chronic shoulder pain is the third most common musculoskeletal dysfunction in medical and physical therapy clinics. It can be influenced by factors beyond the biological, involving beliefs, attitudes, and expectations of the individual. Based on this perspective, introducing Cognitive-Functional Therapy (CFT), a biopsychosocial approach, into physical therapy protocols appears to be beneficial in reducing pain and functional disability.

To report the case of a patient with chronic shoulder pain undergoing CFT as an intervention strategy.

A 48-year-old female patient, a confectioner, reported the onset of pain in her right shoulder approximately 7 months ago while performing underwater swimming upon returning to recreational swimming. The patient underwent a functional assessment and completed pre- and post-intervention questionnaires using the following tools: Shoulder Pain and Disability Index (SPADI), Chronic Pain Self-Efficacy Scale (CPSS), Pain Catastrophizing Scale (PCS), and Numeric Pain Rating Scale (NPRS). Additionally, information about the patient's history before and after the onset of pain was collected. The initial evaluation lasted one and a half hours, and subsequent sessions lasted approximately fifty minutes. The patient expressed a belief in structural damage as the reason for her symptoms but also acknowledged that a lack of physical conditioning contributed to the injury. She reported emotional impact due to the temporary suspension of her work activities because of the pain, as well as difficulty performing household and self-care tasks. The treatment protocol was applied over eight consecutive weeks, with weekly in-person sessions. The approach included reflective questioning to challenge negative beliefs about tissue damage and hypervigilance, gradual exposure to feared movements, and guidance on lifestyle changes. The rehabilitation program was progressive, with a well-established therapeutic alliance. Functional exercises with increasing load and intensity were tailored to the limitations identified during the assessment, including deficits in shoulder flexion, abduction, and internal rotation, as well as activities deemed important to the patient. Home exercise guidance and prescription were also provided.

Initially, the disability assessment showed a SPADI score of 86.92 points. After eight weeks of intervention, this score was reduced to 0.76 points. Additionally, pain decreased from 8 to 1 on the NPRS, indicating improvement in pain and functional capacity. In the self-efficacy assessment, the initial CPSS score was 55.90 points, which decreased to 32.72 after treatment. Finally, catastrophizing, as measured by the PCS, decreased from 20 points at the start to 0 at the end of the protocol (Pre = 20; Post = 0).

The application of CFT over 8 weeks resulted in pain reduction and functional recovery, as well as changes in negative beliefs and pain catastrophizing.

In addition to improving pain, functional capacity, and eliminating negative beliefs and fear of movement, the patient experienced no adverse effects from the therapy throughout the treatment. Therefore, this approach appears to be an appropriate strategy for the treatment of chronic shoulder pain.