The myofascial component of the pain in the painful shoulder of the hemiplegic patient

Abstract

OBJECTIVES: Poststroke shoulder pain occurs very frequently and compromises function and quality of life. Because treatment depends on a multidisciplinary approach, it is desirable to optimize effectiveness. Myofascial pain syndrome is defined by the presence of trigger points that can also be found in spastic stroke patients. The aim of this study was to evaluate the frequency of myofascial pain in the shoulder girdle muscles in patients with poststroke shoulder pain and to document the clinical and functional results obtained with specific treatment for this condition. METHODS: Spastic stroke hemiplegic patients undergoing rehabilitation at the Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School of the University of São Paulo were evaluated regarding the intensity and characteristics of shoulder pain, previous therapeutic interventions, shoulder goniometry and the presence of trigger points. Patients underwent trigger point blockade by intramuscular infiltration of 1% lidocaine. The evaluation and treatment procedures were repeated in the subsequent 3 weeks as long as the pain intensity was greater than 5 on a visual analog scale (VAS). In the fourth week, the evaluation procedures were repeated. Patients who were in a multiprofessional rehabilitation program were instructed to continue the treatment, and the others received complementary therapeutic advice if necessary to initiate it. The evaluations were performed at 0, 1, and 3 weeks and after 4 months. RESULTS: Twenty-one patients (13 men; age=67.8±10.2 years; right hemiparesis: 11) participated in the study, and there was a reduction in pain assessed by VAS from baseline (7.6±2.7) to the first week (5.8±3.6; p <0.05) through the end of the third week (5.2±3.5; p <0.05), but not at the end of four months (6.6±2.9; p =0.11). Good responders had significantly lower pain levels after the third week and presented with a larger range of motion for passive abduction by the end of 4 months. These results demonstrate that the myofascial component of pain should be considered in poststroke shoulder pain and that its treatment may be a pathway for the rapid and long-lasting relief of symptoms. CONCLUSION: Trigger point blockade with lidocaine can reduce pain perception in spastic hemiplegic shoulder in as much as 50% of stroke survivors for four months.

Does Dry Needling Treatment Make an Extra Contribution to Conventional Treatment in Hemiplegic Shoulder Pain? A Randomized Controlled Study

“…23 From this perspective, Liporaci FM et al administered local anesthesia to MTrPs in HSP, and the results indicated that there was a decrease in pain intensity after treatment, while no change was observed at the end of the four-month follow-up. 13 On the other hand, abduction measurements increased significantly. The disadvantage of this study was that conventional rehabilitation was not used in the treatment and there was no control group.…”

“…16 Conditions such as muscle imbalance, postural disorders, immobilization, and emotional stress in stroke patients may cause both the emergence of MTrP and the activation of latent MTrP in the shoulder region. 6,13 As a result, a multimodal treatment approach is offered by both attempting to restore the neurological deficit and targeting MTrP. In this context, this study aimed to evaluate whether combining DN treatment with conventional rehabilitation contributes to improving pain, joint range of motion, and functionality parameters and clarify the significance of MTrP in HSP.…”

“…6 Among the studies examining MTrP in HSP treatment, there are some current ones using the myofascial release technique, local anesthesia, and DN treatments. [12][13][14]17 In general, these studies combined MTrP therapy with conventional rehabilitation. Indeed, evaluating MTrP treatment as the primary treatment would be an incomplete approach for a complex pathology like HSP.…”

“…11 Furthermore, some studies have used local anesthetic and DN for the treatment of MTrPs that cause HSP. [12][13][14] There are limitations in these studies, such as the number of sessions and the muscles treated are not standardized, and the follow-up periods are short. The present study aims to show that DN treatment performed in addition to conventional rehabili-tation practices provides additional improvement in patients' pain, joint range of motion, and functionality parameters.…”

The Case for Comorbid Myofascial Pain—A Qualitative Review

“…In another observational study, de Oliveira et al examined 40 patients with central post-stroke pain, observing MPS in 67.5% of them [ 55 ]. Several studies explored the clinical efficacy of treating the myofascial component of post-stroke pain, demonstrating reduced pain intensity and improved range of motion [ 56 ] as well as improved balance and function [ 57 ].…”