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

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 11; pp. 1968 - 1974
• Main Authors: Roosink, Meyke, PhD, Van Dongen, Robert T., MD, PhD, Buitenweg, Jan R., PhD, Renzenbrink, Gerbert J., MD, Geurts, Alexander C., MD, PhD, IJzerman, Maarten J., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2012; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Central nervous system sensitization; Cold Temperature; Diseases of the osteoarticular system; Female; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Miscellaneous. Osteoarticular involvement in other diseases; Neurology; Pain Threshold; Physical Medicine and Rehabilitation; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Sensory thresholds; Shoulder pain; Shoulder Pain - etiology; Somatosensory Disorders - etiology; Stroke; Stroke - complications; Stroke Rehabilitation; Vascular diseases and vascular malformations of the nervous system; CPM; PSSP; EPT; electrical sensation threshold; poststroke shoulder pain; EPTT; Central nervous system sensitization; pain-free stroke patients; PPT; tactile detection threshold; persistent poststroke shoulder pain; NoPSSP; pressure pain threshold; quantitative sensory testing; pPSSP; Stroke; neuropathic pain diagnostic questionnaire; TDT; electrical pain threshold; EST; VDT; DN4; conditioned pain modulation; Sensory thresholds; electrical pain tolerance threshold; QST; Rehabilitation; Shoulder pain; vibration detection threshold; Nervous system diseases; Diseases of the osteoarticular system; Central nervous system; Cardiovascular disease; Painful shoulder; Cerebral disorder; Vascular disease; Reeducation; Orthopedics; Central nervous system disease; Cerebrovascular disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2012.05.019

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.