Abstract
Roosink M, Van Dongen RT, Buitenweg JR, Renzenbrink GJ, Geurts AC, IJzerman MJ. Multimodal
and widespread somatosensory abnormalities in persistent shoulder pain in the first
6 months after stroke: an exploratory study.
Objective
To explore the role of multimodal and widespread somatosensory abnormalities in the
development of persistent poststroke shoulder pain (pPSSP) in the first 6 months after
stroke.
Design
Prospective inception cohort study.
Setting
Stroke units of 2 teaching hospitals.
Participants
The data of a strict selection of patients (N=31) with a clinical diagnosis of stroke
were analyzed.
Interventions
Not applicable.
Main Outcome Measures
The development of pPSSP within the first 6 months after stroke. Bilateral sensation
and pain thresholds at 3 (t1) and 6 (t2) months, and conditioned pain modulation (CPM)
at 3 months after stroke. Clinical examination within 2 weeks after stroke (t0), at
t1, and at t2.
Results
pPSSP (n=9) was associated with increased sensation and pain threshold ratios at the
affected side (t1, t2), and with reduced cold pain tolerance at the unaffected side
(t1). CPM was not different from patients without pPSSP (n=22). Notably, in patients
with pPSSP reporting increased sensation on clinical examination, multiple body sites
across multiple stimulus modalities were involved, and increased sensation persisted
from t1 to t2.
Conclusions
pPSSP in the first 6 months after stroke was associated with somatosensory loss to
both innocuous and noxious stimuli (affected side). In addition, pPSSP was associated
with sensitization to cold pain (unaffected side) and with widespread sensitization
to multimodal innocuous stimuli (affected side). The results support the notion that
central somatosensory sensitization could play an important role in the development
of pPSSP, the maintenance of pPSSP, or both.
Key Words
List of Abbreviations:
CPM (conditioned pain modulation), DN4 (neuropathic pain diagnostic questionnaire), EPT (electrical pain threshold), EPTT (electrical pain tolerance threshold), EST (electrical sensation threshold), NoPSSP (pain-free stroke patients), pPSSP (persistent poststroke shoulder pain), PPT (pressure pain threshold), PSSP (poststroke shoulder pain), QST (quantitative sensory testing), TDT (tactile detection threshold), VDT (vibration detection threshold)To read this article in full you will need to make a payment
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References
- Post stroke shoulder pain: more common than previously realized.Eur J Pain. 2000; 4: 313-315
- Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke.Eur J Pain. 2002; 6: 467-474
- Shoulder pain after stroke: a prospective population-based study.Stroke. 2007; 38: 343-348
- Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study.Arch Phys Med Rehabil. 2011; 92: 1139-1145
- Shoulder pain in people with a stroke: a population-based study.Clin Rehabil. 2003; 17: 304-311
- Somatosensory symptoms and signs and conditioned pain modulation in chronic post-stroke shoulder pain.J Pain. 2011; 12: 476-485
- Altered cortical somatosensory processing in chronic stroke: a relationship with post-stroke shoulder pain.NeuroRehabilitation. 2011; 28: 331-344
- Classifying post-stroke shoulder pain: can the DN4 be helpful?.Eur J Pain. 2011; 15: 99-102
- Relationship among shoulder proprioception, kinematics, and pain after stroke.Arch Phys Med Rehabil. 2009; 90: 1557-1564
- Underlying pathology and associated factors of hemiplegic shoulder pain.Am J Phys Med Rehabil. 2011; 90: 768-780
- Central hypersensitivity in chronic pain: mechanisms and clinical implications.Phys Med Rehabil Clin N Am. 2006; 17: 287-302
- Towards a mechanism-based view on post-stroke shoulder pain: theoretical considerations and clinical implications.NeuroRehabilitation. 2012; 30: 153-165
- Depression and changed pain perception: hints for a central disinhibition mechanism.Pain. 2008; 140: 332-343
- Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway.Clin Rehabil. 2002; 16: 231-247
- A neurocognitive model of attention to pain: behavioral and neuroimaging evidence.Pain. 2009; 144: 230-232
- Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes.J Am Geriatr Soc. 2002; 50: 700-706
- Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).Pain. 2005; 114: 29-36
- Assessing motor impairment after stroke: a pilot reliability study.J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
- Merskey H. Bogduk N. Classification of chronic pain. 2nd ed. IASP Pr, Seattle1994
- Linguistic validation of the DN4 for use in international studies.Eur J Pain. 2010; 14: 58-63
- The Kyoto protocol of IASP Basic Pain Terminology.Pain. 2008; 137: 473-477
- Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values.Pain. 2006; 123: 231-243
- The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans.Pain. 2009; 144: 16-19
- Perspective on diffuse noxious inhibitory controls as a model of endogenous pain modulation in clinical pain syndromes.J Pain. 2010; 11: 408-419
- Recommendations on terminology and practice of psychophysical DNIC testing.Eur J Pain. 2010; 14: 339
- A psychophysical study of endogenous analgesia: the role of the conditioning pain in the induction and magnitude of conditioned pain modulation.Eur J Pain. 2011; 15: 491-497
- Quantitative sensory testing: a comprehensive protocol for clinical trials.Eur J Pain. 2006; 10: 77-88
- Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation.Arch Phys Med Rehabil. 2008; 89: 1589-1593
- Predictor factors of hemiplegic shoulder pain in a group of stroke patients.Iran Red Crescent Med J. 2008; 10: 215-219
- Painful hemiplegic shoulder.University of Western Ontario, London2007
- Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study.Eur J Pain. 2005; 9: 561-569
- Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.Pain. 2008; 138: 22-28
- Central post-stroke pain: clinical characteristics, pathophysiology, and management.Lancet Neurol. 2009; 8: 857-868
- Central poststroke pain: a population-based study.Pain. 2011; 152: 818-824
- Modulatory influence on somatosensory perception from vibration and heterotopic noxious conditioning stimulation (HNCS) in fibromyalgia patients and healthy subjects.Pain. 1997; 70: 41-51
- Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief.Pain. 2000; 88: 69-78
- Influence of heterotopic noxious conditioning stimulation on spontaneous pain and dynamic mechanical allodynia in central post-stroke pain patients.Pain. 2009; 143: 84-91
- The methodology of experimentally induced diffuse noxious inhibitory control (DNIC)-like effect in humans.Pain. 2009; 144: 16-19
- Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.Neurology. 2003; 60: 898-904
- Defining post-stroke pain: diagnostic challenges.Lancet Neurol. 2010; 9 ([letter]): 344
- Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia.Clin Rehabil. 2004; 18: 359-365
- Enduring representational plasticity after somatosensory stimulation.Neuroimage. 2005; 27: 872-884
- Sensorimotor training and cortical reorganization.NeuroRehabilitation. 2009; 25: 19-27
- Stroke, complex regional pain syndrome and phantom limb pain: can commonalities direct future management?.J Rehabil Med. 2007; 39: 109-114
Article info
Publication history
Published online: June 07, 2012
Footnotes
Supported by the AMPHoraest Foundation, Leusden, The Netherlands.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Clinical Trial Registration No: NTR1746.
In-press corrected proof published online on Jul 15, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
