Original article| Volume 93, ISSUE 11, P1968-1974, November 2012

Multimodal and Widespread Somatosensory Abnormalities in Persistent Shoulder Pain in the First 6 Months After Stroke: An Exploratory Study


      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.


      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.


      Prospective inception cohort study.


      Stroke units of 2 teaching hospitals.


      The data of a strict selection of patients (N=31) with a clinical diagnosis of stroke were analyzed.


      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.


      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.


      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)
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