The neuronal circuits responsible for processing pain and emotion are functionally shared. Emotional patterns can be understood by the defensive motivational state, characterized by low valence (unpleasant), and by the appetitive state characterized by high valence (pleasant). Furthermore, people with shoulder pain understand their own pain from the biomechanical perspective, in which they believe that movement can cause tissue damage.

We aimed verify if there is an association between hedonic valence, harm-belief of shoulder movement and shoulder pain and disability index.

This is a cross-sectional observational study. We included people with different shoulder musculoskeletal disorders, shoulder pain for at least three months, average intensity of at least 3 on the Numerical Pain Scale (NPS) and over eighteen years old. We excluded people with difficulties in understanding the questionnaires, the presence of a tumor and visual. The Shoulder Pain and Disability Index (SPADI) was applied to assess the shoulder pain and disability index. Participants viewed 58 movements images involving the shoulder complex. They judged valence using the Self-Assessment Manikin (SAM) scale for each image. The scale is composed of drawings of mannequins with expressions ranging from sad/unhappy (1) to pleasant/happy (9). The participants made an “x” on the manikin that represented their emotion right after viewing the image. The following question was asked for each image to assess the harm-belief “How much do you believe that this activity could harm your shoulder?”. The answers were made with an “x” on a numerical scale. A score of 0 represents not at all harmful and 10 represents very harmful. Multiple Linear Regression was performed using the hierarchical method to verify the association between harm-belief and SPADI (independent variables) and valence (dependent variable). The necessary assumptions for this analysis were evaluated and we considered 20 participants for each independent variable.

Participated 42 people with chronic shoulder pain. The mean and standard deviation (SD) of age were 45.7(13). The SPADI mean and SD were 57.1(24.1). Multiple linear regression analysis resulted in a significant model [F(2.39)=12.971;p<0.001;R²=0.369]. The harm-belief was negatively associated with valence (β=-0.832;t=-4.670;p<0.001). The pain and disability index was not associated with valence (β=0.344;t=1.934;p=0.06).

There is an association between valence and harm-belief of movements images. People with shoulder pain who find movements images unpleasant may believe that movement can harm shoulder pain. Harm-belief associated with a negative emotional state can lead to exacerbated fear of movement and, consequently, avoidance behavior.

We present the association of emotional aspects and harm-belief of movement in people with shoulder pain. It is crucial for the clinician to understand these aspects in order to improve patient treatment. In this way, providing improvement in pain, function and breaking the fear-avoidance cycle of movement.