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Central hypersensitivity in chronic hemiplegic shoulder pain
Jennifer Soo Hoo1, Tracy Paul, John Chae
1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
American Journal of Physical Medicine & Rehabilitation
|December 21, 2012
Summary
Patients with hemiplegic shoulder pain (HSP) exhibit lower pressure-pain thresholds (PPTs) in both local and distant tissues. This suggests widespread central hypersensitivity may contribute to chronic shoulder pain, potentially informing new treatment strategies.
Area of Science:
- Neurology
- Pain Medicine
- Rehabilitation Science
Background:
- Hemiplegic shoulder pain (HSP) is a common complication following stroke.
- Central hypersensitivity is implicated in various chronic pain conditions.
- The relationship between HSP and central hypersensitivity requires further investigation.
Purpose of the Study:
- To investigate the association between hemiplegic shoulder pain (HSP) and central hypersensitivity.
- To measure pressure-pain thresholds (PPTs) in patients with HSP and control groups.
- To assess PPTs in local and distant tissues to identify potential widespread hypersensitivity.
Main Methods:
- A cross-sectional study involving 40 stroke patients (20 with HSP, 20 without HSP).
- Pressure-pain thresholds (PPTs) were measured using a handheld algometer on the affected deltoid, contralateral deltoid, and tibialis anterior.
- Statistical analysis included Wilcoxon's rank-sum test and linear regression, controlling for sex.
Main Results:
- Subjects with HSP demonstrated significantly lower PPTs in the affected shoulder compared to controls.
- Lower PPTs were also observed in the non-painful shoulder and tibialis anterior of HSP patients.
- These findings indicate reduced pain thresholds in both local and distant sites for individuals with HSP.
Conclusions:
- Hemiplegic shoulder pain is associated with lower local and distal pressure-pain thresholds.
- The results suggest that chronic shoulder pain post-stroke may involve widespread central hypersensitivity.
- Understanding this association may lead to improved therapeutic interventions for HSP.
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