Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain

Abstract

Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain.

Functional Changes during Hospital Stay in Older Patients Admitted to an Acute Care Ward: A Multicenter Observational Study

“…These other studies either excluded subjects unable to perform PPMs [25] or assessed changes after only one week of hospital stay [28]. In our study, subjects unable to perform had the greatest functional change and 65% of subjects stayed in hospital longer than seven days.…”

“…Stabilisation of the acute medical condition may outweigh the negative consequences of hospital stay on physical function [25].…”

Fully Implantable Peripheral Nerve Stimulation for the Treatment of Hemiplegic Shoulder Pain

“…28 Improved biomechanics is unlikely as the RCT that only enrolled participants with glenohumeral subluxation failed to show evidence of improved motor function or reduction of subluxation. 10,13 Two more recent trials enrolled stroke patients with and without glenohumeral subluxation; 9,14 however, participants in both groups experienced significant pain reduction, which further suggests that improved biomechanics of the glenohumeral joint is not the mechanism of action.…”

“…Finally, PNS may modulate central sensitization, which has been shown to be present in chronic HSP 28 as well as in multiple other chronic musculoskeletal pain conditions. 30 Data in support of this hypothesis are emerging, but are preliminary.…”

An Etiological Paradigm Shift for Chronic Hemiplegic Shoulder Pain

“…2-4 Furthermore, there is a growing body of evidence to suggest that the nociceptive and biomechanical models should be reconsidered in favor of a central sensitization process in the etiology of chronic HSP. 5-8 …”