The investigation of the effects of attentional focus strategies on pain, disability, posture, quality of life and depression in patients with myofascial pain syndrome

The study aims to investigate the effects of different attentional focus strategies—internal, external, and no attentional focus—on pain, pressure pain threshold (PPT), disability, posture, quality of life (QOL), and depression in patients with neck and upper back Myofascial Pain Syndrome (MPS). This study was conducted at Istanbul Kadıköy Florence Nightingale Hospital between February 2024 and March 2025. A total of 36 participants aged between 18-65 were included voluntarily. Patients with a physician-confirmed diagnosis of MPS in the neck and upper back, who have experienced pain lasting over 3 months with an intensity rating of 3 or higher on the Numeric Pain Rating Scale (NPRS), were included. Participants were randomly divided into three groups: External Focus Group (EFG), Internal Focus Group (IFG), and Control Group (CG). All groups followed the same exercise program, differing only in verbal instructions that directed attention to the internal, external, or no instructions.The exercise program included strengthening and stretching exercises during six weeks, twice a week (12 sessions total). Each session lasted approximately 45 minutes in the same environment and with the same physiotherapist. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), and PPT was measured with a digital algometer. Disability was assessed using the Neck Disability Index (NDI), postural assessment was conducted using the New York Posture Rating Chart (NYPRC), QOL was measured with the SF-12 questionnaire, and depression levels were evaluated using the Beck Depression Inventory (BDI). Our main results demonstrate improvements in pain, PPT, disability, posture, physical component score of QOL, and depression parameters in all three groups (p<0.05). The mental component of QOL showed a statistically significant difference only in the attentional focus groups (p<0.05). Between-group analysis showed that EFG demonstrated a significantly greater improvement in PPT compared to IFG (p < 0.05). No significant differences were found between the groups in the other parameters. Key Words: Myofascial Pain Syndrome, Attentional Focus, Exercise