POST STROKE PAIN-MECHANISMS, CLINICAL MANIFESTATIONS AND REHABILITATION INTERVENTIONS

Authors

  • Adrian MELNIC Department of Medical Rehabilitation, Physical Medicine and Manual Therapy, Institute of Neurology and Neurosurgery " Diomid Gherman”
  • Svetlana PLESHKA Department of Medical Rehabilitation, Physical Medicine and Manual Therapy State University of Medicine and pharmacy ”Nicolae Testemitanu"; Institute of Neurology and Neurosurgery ”Diomid Gherman”
  • Oleg PASCAL Department of Medical Rehabilitation, Physical Medicine and Manual Therapy State University of Medicine and pharmacy ”Nicolae Testemitanu"; Institute of Neurology and Neurosurgery ”Diomid Gherman”
  • Anastasia BILAN Department of Medical Rehabilitation, Physical Medicine and Manual Therapy State University of Medicine and pharmacy ”Nicolae Testemitanu”
  • Marina SANGHELI Department of Neurology no. 1, State University of Medicine and pharmacy ”Nicolae Testemitanu", Institute of Neurology and Neurosurgery ”Diomid Gherman”

DOI:

https://doi.org/10.52692/1857-0011.2021.3-71.27

Keywords:

post stroke pain, central pain, complex regional pain syndrome, shoulder pain, stroke rehabilitation

Abstract

Introduction. Different painful syndromes and comorbidities can often occur in stroke survivors; thus, pain management remains a strong issue that interferes with the rehabilitation programs and contributes to poor functional outcomes. Painful conditions can be regarded as comorbidities or complications of stroke itself, which makes the rehabilitation more difficult. The aim of the research was to investigate the types and causes of pain after stroke and the possibilities of rehabilitation interventions for pain control. Methods: A multiple directed literature research was conducted using the key words “stroke”, “pain”, “stroke rehabilitation” and “painful comorbidities” in PubMed, Google scholar databases.  Results: The most common types of pain associated with stroke to be found were: shoulder pain, complex regional pain syndrome, central post-stroke pain and headache. Usually, musculoskeletal disorders and pain related to spasticity can lead to chronic suffering, and are related to loss of function. In some cases, different causes of pain can overlap in stroke patients. Discussion: Rehabilitation interventions in stroke can be regarded as a solution or an additional treatment to painful syndromes. Physical therapy methods, movement therapy, heat and cold therapies or TENS can serve as therapeutical and rehabilitation options for shoulder pain, pain related to spasticity or musculoskeletal disorders. A multidisciplinary approach that consists of pharmacological and physical treatments is requested in most of the cases. Conclusion: Post-stroke pain is a common clinical feature, but also a very heterogeneous one, with multiple causes and characteristics. Rehabilitation methods bring new insights and can be regarded as additional instruments for pain treatment in stroke survivors.

References

Klit, H., Finnerup, N. B., Overvad, K., Andersen,G., & Jensen, T. S. (2011). Pain following stroke: a population-based follow-up study. PloS one, 6(11), e27607.https://doi.org/10.1371/journal.pone.0027607

Westerlind, E., Singh, R., Persson, H. C., & Sunnerhagen,K. S. (2020). Experienced pain after stroke: a cross-sectional 5-year follow-up study. BMC Neurology, 20(1). https://doi.org/10.1186/s12883-019-1584-z

Schuster J, Hoyer C, Ebert A, Alonso A. Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study. BMC Neurol. 2020 Jan 14;20(1):18. doi: 10.1186/s12883-020-1606-x. PMID:31937259; PMCID: PMC696129

Hebert, D. (2016). Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines,update 2015. International Journal of Stroke, 11(4),459–484.

O’Donnell, M. J. (2013). Chronic Pain Syndromes After Ischemic Stroke. Stroke, 44(5), 1238–1243.

Hansen, A. (2012). Pain following stroke: A prospective study. European Journal of Pain, 16(8), 1128–1136.

Harrison, R. A. (2015b). Post Stroke Pain: Identification,Assessment, and Therapy. Cerebrovascular Diseases,39(3–4), 190–201.

Sayat, A. R. G. (2019). Assessment and Treatment of Central Post-Stroke Pain: an Overview. British Journal of Neuroscience Nursing, 15(Sup2), S4–S9.

Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol. 2009;8(9):857-868. doi:10.1016/S1474-4422(09)70176-0

Osama, A. (2018). Central post-stroke pain: predictors and relationship with magnetic resonance imaging and somatosensory evoked potentials. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 54(1).

Oh, H. (2015). A Comprehensive Review of Central Post-Stroke Pain. Pain Management Nursing, 16(5), 804–818.

Winstein, C. J. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery. Stroke, 47(6).

Kim, J. S. (2003). Central post-stroke pain or paresthesia in lenticulo-capsular hemorrhages. Neurology, 61(5), 679–682.

Choi-Kwon, S. (2016). Musculoskeletal and central pain at 1 year post-stroke: associated factors and impact on quality of life. Acta Neurologica Scandinavica, 135(4), 419–425.

Widar, M. (2002). Long-term pain conditions after a stroke. Journal of Rehabilitation Medicine, 34(4), 165–170.

Kumar, B. (2009). Central Poststroke Pain: A Review of Pathophysiology and Treatment. Anesthesia & Analgesia, 108(5), 1645–1657.

Akyuz, G. (2016). Systematic Review of Central Post Stroke Pain. American Journal of Physical Medicine & Rehabilitation, 95(8), 618–627.

Bae, S. H. (2014). Analgesic Effect of Transcranial Direct Current Stimulation on Central Post-Stroke Pain. The Tohoku Journal of Experimental Medicine, 234(3), 189–195.

Rebordão, L. (2020). Stroke chameleons: acute central pain mimicking acute coronary syndrome. European Journal of Neurology, 27(11), 2312–2317.

Vartiainen, N. (2016). Thalamic pain: anatomical and physiological indices of prediction. Brain, 139(3), 708–722.

Klit, H. (2011a). Central poststroke pain: A population-based study. Pain, 152(4), 818–824.

Nadler, M. (2020). Shoulder pain after recent stroke (SPARS): hemiplegic shoulder pain incidence within 72 hours post-stroke and 8–10 week follow-up (NCT 02574000). Physiotherapy, 107, 142–149.

Amer, M. (2019). A clinical, electrophysiological, and imaging study on the different causes of poststroke shoulder pain. The Journal of the International Society of Physical and Rehabilitation Medicine, 2(1), 35.

Topcuoglu, A. (2015). The effect of upper-extremity aerobic exercise on complex regional pain syndrome type I: a randomized controlled study on subacute stroke. Topics in Stroke Rehabilitation, 22(4), 253–261.

McLean, D. E. (2004). Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 85(3), 466–469.

Koyuncu, E. (2016). Coexistence of Deep Vein Thrombosis, Heterotopic Ossification, and Complex Regional Pain Syndrome due to Hemorrhagic Stroke. Journal of Stroke and Cerebrovascular Diseases, 25(3), e38–e40.

McCarberg, B. H. (2001). Long-Acting Opioids for Chronic Pain: Pharmacotherapeutic Opportunities to Enhance Compliance, Quality of Life, and Analgesia.American Journal of Therapeutics, 8(3), 181–186.

Altas, E. U. (2020). Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center. Journal of Stroke and Cerebrovascular Diseases, 29(9), 104995.

Kondo, I. (2001). Protocol to prevent shoulder-hand syndrome after stroke. Archives of Physical Medicine and Rehabilitation, 82(11), 1619–1623.

Ordu Gokkaya, N. K. (2006). Reflex sympathetic dystrophy in hemiplegia. International Journal of Rehabilitation Research, 29(4), 275–279.

Dursun, E. (2000). Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients.Archives of Physical Medicine and Rehabilitation, 81(7), 944–946.

Juottonen, K. (2002). Altered central sensorimotor processing in patients with complex regional pain syndrome. Pain, 98(3), 315–323.

Schinkel, C. (2006). Inflammatory Mediators are Altered in the Acute Phase of Posttraumatic Complex Regional Pain Syndrome. The Clinical Journal of Pain, 22(3), 235–239.

Okudan, B. (2005). Determination of inflammation of reflex sympathetic dystrophy at early stages with Tc-99m HIG scintigraphy: preliminary results. Rheumatology International, 26(5), 404–408.

Koban, M. (2003). Tissue hypoxia in complex regional pain syndrome. Pain, 104(1), 149–157.

Cacchio, A. (2009). Mirror Therapy in Complex Regional Pain Syndrome Type 1 of the Upper Limb in Stroke Patients. Neurorehabilitation and Neural Repair,23(8), 792–799.

Corbetta, D. (2018). Mirror therapy for an adult with central post-stroke pain: a case report. Archives of Physiotherapy, 8(1).

Merritt, W. H. (2005). The Challenge to Manage Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome. Clinics in Plastic Surgery, 32(4), 575–604.

Pervane Vural S, Nakipoglu Yuzer GF, Sezgin Ozcan D, Demir Ozbudak S, Ozgirgin N. Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study. Arch Phys Med Rehabil. 2016 Apr;97(4):575-581. doi: 10.1016/j.apmr.2015.12.008. Epub 2015 Dec 23. PMID: 26723854.

Altas EU, Onat ŞŞ, Konak HE, Polat CS. Post-stroke complex regional pain syndrome and related factors: Experiences from a tertiary rehabilitation center. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104995. doi:10.1016/j.strokecerebrovasdis.2020.104995. Epub 2020 Jul 3. PMID: 32807418.

Palmer G. Complex regional pain syndrome.Aust Prescr. 2015 Jun;38(3):82-6. doi: 10.18773/austprescr. 2015.029. Epub 2015 Jun 1. PMID:26648626; PMCID:PMC4653964.

Kwah LK, Harvey LA, Diong JH, Herbert RD:Half of the adults who present to hospital with stroke develop at least one contracture within six months: an observational study. J Physiother 2012;58:41–47.

Treister AK, Hatch MN, Cramer SC, Chang EY. Demystifying Poststroke Pain: From Etiology to Treatment. PM R. 2017 Jan;9(1):63-75. doi: 10.1016/j. pmrj.2016.05.015. Epub 2016 Jun 16. PMID: 27317916; PMCID: PMC5161714.

Hansen AP, Marcussen NS, Klit H, Kasch H, Jensen TS, Finnerup NB. Development of persistent headache following stroke: A 3-year follow-up. Cephalalgia. 2015;35(5):399-409

Lai, J. (2018). A Narrative Review of Persistent Post-Stroke Headache - A New Entry in the International Classification of Headache Disorders, 3rd Edition. Headache:The Journal of Head and Face Pain, 58(9), 1442–1453

Plecash AR, Chebini A, Ip A, et al. Updates in the Treatment of Post-Stroke Pain. Curr Neurol Neurosci Rep. 2019;19(11):86. Published 2019 Nov 13. doi:10.1007/s11910-019-1003-2

Gierthmühlen, J., Binder, A. & Baron, R. Mechanism-based treatment in complex regional pain syndromes.Nat Rev Neurol 10, 518–528 (2014).

Han P, Zhang W, Kang L, et al. Clinical Evidence of Exercise Benefits for Stroke. Adv Exp Med Biol.2017;1000:131-151. doi:10.1007/978-981-10-4304-8_9

Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag. 2020;16:75-85. Published 2020 Feb 7. doi:10.2147/TCRM.S206883

Viana R, Pereira S, Mehta S, Miller T, Teasell R. Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review. Top Stroke Rehabil. 2012;19(6):514-522.

Mok E, Woo CP. The effects of slow-stroke back massage on anxiety and shoulder pain in elderly stroke patients. Complement Ther Nurs Midwifery. 2004;10(4):209-216. 52. Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions:focus on neuropathic pain. Expert Rev Neurother. 2011;11(5):735-753. doi:10.1586/ern.11.48

Published

2021-11-17

Issue

Section

Research Article