Frequency and features of the central poststroke pain

Vukojevic, Zoran; Kovacevic, Aleksandra Dominovic; Perić, Stojan; Grgić, Sanja; Bjelica, Bogdan; Basta, Ivana; Lavrnić, Dragana

doi:10.1016/j.jns.2018.06.004

Cited by 17 publications

(14 citation statements)

References 16 publications

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“…Twenty-three studies provided data regarding the stroke location in non-selected populations of patients with CPSP [22,23,30,33,36,43,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. The majority of patients with CPSP suffered a thalamic stroke (42%, 95% CI 33-52%, I 2 = 79%), followed by lobar strokes (21%, 95% CI 14-30%, I 2 = 74%), strokes in the basal ganglia (16%, 95% CI 11-23%, I 2 = 63%), brainstem strokes (14%, 95% 11-17%, I 2 = 0%), and cortical strokes (9%, 95% CI 5-16%, I 2 = 72%).…”

Section: Stroke Location In Patients With Cpspmentioning

confidence: 99%

Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

et al. 2020

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Introduction: Central post-stroke pain (CPSP) is defined as the neuropathic pain that arises either acutely or in the chronic phase of a cerebrovascular event and is a result of central lesions of the somatosensory tract. The aim of this systematic review and meta-analysis was to establish the prevalence of CPSP, to describe its characteristics, and to discuss the associated management challenges. Methods: After a systematic Medline search, we identified 69 papers eligible to be included. Results: The pooled prevalence of CPSP in patients with stroke at any location was 11% (95% CI 7-18%), which can increase to more than 50% in the subgroups of patients with medullary or thalamic strokes. CPSP onset coincides with stroke occurrence in 26% of patients (95% CI 18-35%); CPSP manifests within a month since symptom onset in 31% of patients (95% CI 22-42%), and occurs between the first month and the first year in 41% of patients (95% CI 33.9-49.0%). CPSP develops more than 12 months after stroke onset in 5% of patients (95% CI 3-8%). Conclusions: Clinicians should look for any evidence of central neuropathic pain for at least 12 months after stroke. Both pharmacological and non-pharmacological interventions can be used for the management of CPSP. Lamotrigine has the strongest evidence (Level II of evidence, derived from small randomized controlled trials) for being effective in the management of CPSP. Future research should focus on well-designed trials of pharmacological and non-pharmacological interventions aiming to relief CPSP, which is a very common but often neglected pain syndrome.

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Section: Stroke Location In Patients With Cpspmentioning

confidence: 99%

Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

et al. 2020

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“…Nine studies only included patients with first-ever stroke [13][14][15][18][19][20][21][22][23][24], while 2 studies did not exclude patients with previous studies [9,10]. Eight studies did not mention the selection criterion about stroke history [11,12,16,17,[24][25][26][27]. Since different lesion site of stroke may have different effect, it is difficult to distinguish the impact of recurrent stroke with different lesion location.…”

Section: Bias From Inclusion Criterionmentioning

confidence: 99%

“…There are several methods for pain measurement, such as Visual Analogue Scale (VAS) (5 studies [9,17,18,20,24]), numerical rating system (NRS) (5 studies [14,15,22,23,25]), Douleur neuropatathique en 4 questions (DN4) (3 studies [22,25,27]), The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) (2 studies [24,25]) or combined assessment. The check of PSSP is always companied with assessment of upper-limp.…”

Section: Bias From Psp Definitionmentioning

confidence: 99%

Cerebral Stroke Lesion Location and the Risk of Post-Stroke Pain A Systematic Review and Meta-Analysis

Yuan¹,

Wang²,

Wang³

et al. 2020

Preprint

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Background Post-stroke pain (PSP) is generally a severe complication in stroke rehabilitation. It is always associated with allodynia and hyperalgesia to nociceptive stimuli. Previous studies believed that PSP was related with tissue injury at certain brain territory, possibly thalamic lesion. However, there is very little evidence that the risk of PSP has a salient association with the side of lesion location (left or right hemisphere). The aim of this study was to assess the relationship between the occurrence of PSP and the lesion location of stroke.Methods We selected relevant literatures by searching EMBASE, ISI Web of Science, PubMed, and systematically reviewed available publications according to predetermined inclusion criterion. Subgroup analyses were performed according to the subtype of PSP. The pooled risk estimates were calculated by using a randomized-effects model.Results A total of 19 studies involving 2038 patients suffered from cerebral stroke were included. Meta-analysis showed no significant relationship between brain lesion location and the risk of PSP (OR=0.95 95% CI 0.74–1.23). Subgroups analyses showed that the incidence of post-stroke shoulder pain (PSSP) or central post-stroke pain (CPSP) was also not associated with the side of brain lesion (PSSP: OR=0.91, 95% CI 0.57–1.46; CPSP: OR=0.99, 95% CI 0.70–1.40). The pooled result of prospective studies had similar result (RR=1.02, 95% CI 0.84-1.25). Evidence of publication bias has not been found using visual inspection of a funnel plot and Begg’s and Egger’s tests.Conclusions Our systematic meta-analysis suggests that the lesion location of stroke has no significant association with the incidence of post-stroke pain. Further studies are needed to detect the risk factors for PSP, which may contribute to the prevention, identification and management of PSP.

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“…1) The prevalence of CPSP varies from 1 to 14%. 2–4) Pain is severe, persistent, and spontaneous on the hemiplegic side. The main feature of the spontaneous pain associated with CPSP has been described as a burning or aching that often co-exists with sensory disturbances such as allodynia or hypoesthesia.…”

Section: Introductionmentioning

confidence: 99%

“…The main feature of the spontaneous pain associated with CPSP has been described as a burning or aching that often co-exists with sensory disturbances such as allodynia or hypoesthesia. 1–4) Although the mechanisms of CPSP are still unclear, spinothalamocortical pathway injury appears to be crucial for the development of CPSP. 3–5) Pharmacological treatment of CPSP mainly consists of the use of pregabalin, antidepressants, and opioid.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain

Tanei

Kajita

Takebayashi

et al. 2019

Neurol. Med. Chir.(Tokyo)

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The efficacy and predictive factors associated with successful spinal cord stimulation (SCS) for central post-stroke pain (CPSP) have yet to be definitively established. Thus, this study evaluated the rates of pain relief found after more than 12 months and the predictive factors associated with the success of SCS for CPSP. The degree of pain after SCS in 18 patients with CPSP was assessed using the Visual Analog Scale preoperatively, at 1, 6 and 12 months after surgery, and at the time of the last follow-up. After calculating the percentage of pain relief (PPR), patients were separated into two groups. The first group exhibited continuing PPR ≥30% at more than 12 months (effect group) while the second group exhibited successful/unsuccessful trials followed by decreasing PPR <30% within 12 months (no effect group). Pain relief for more than 12 months was achieved in eight out of 18 (44.4%) patients during the 67.3 ± 35.5 month follow-up period. Statistically significant differences were found for both the age and stroke location during comparisons of the preoperative characteristics between the two groups. There was a significantly younger mean age for the effect versus the no effect group. Patients with stoke in non-thalamus were significantly enriched in effect group compared with those with stoke in thalamus. Multivariable analysis using these two factors found no statistical differences, suggesting that these two factors might possibly exhibit the same behaviors for the SCS effect. These results suggest that SCS may be able to provide pain relief in young, non-thalamus stroke patients with CPSP.

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Frequency and features of the central poststroke pain

Cited by 17 publications

References 16 publications

Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

Cerebral Stroke Lesion Location and the Risk of Post-Stroke Pain A Systematic Review and Meta-Analysis

Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain

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