Pressure pain threshold and somatosensory abnormalities in different ages and functional conditions of post-stroke elderly

Abstract

Background Somatosensory deficits and abnormal pain sensitivity are highly prevalent among stroke survivors, which negatively impacts their quality of life and recovery process. However, the factors for pressure pain threshold (PPT) and somatosensory abnormalities in post-stroke elderly remain unknown. The aim of this study was to explore the effects of age, side and other functional conditions, such as spasticity and motor functions, on PPT and sensory abnormalities among elderly after stroke. Methods The cross-sectional study finally included 43 post-stroke elderly aged over 60 and assessed the PPT of 14 bilateral muscles widely located in the whole body by using a digital force gage. Meanwhile, spasticity, motor function, joint pain and activity of daily living (ADL) were evaluated by the Modified Ashworth scale, Fugl-Meyer, and Barthel Index, respectively. All participants were divided into higher-aged and lower-aged groups based on the median age of all of them. Results Higher age tended to be associated with higher sensitivity but not significant except for one upper limb muscle, and the affected side showed significantly higher PPTs than the unaffected side in three out of seven muscles (p < 0.05). Furthermore, the somatosensory abnormalities in the affected side, particularly hypoalgesia, were more frequent in higher-aged than lower-aged patients in most assessed muscles. Meanwhile, patients with spasticity showed more increment of PPTs in affected muscles around the knee joint than patients without spasticity (p < 0.05). Patients with better motor functions, less joint pain and higher ADL performed less bilateral differences of PPTs than other patients in some muscles (p < 0.05). Conclusions The age and side differences of mechanical pain sensitivity were found among post-stroke elderly. Older patients show higher sensitivity in both sides compared with the younger ones, and the affected side of the elder shows more somatosensory abnormalities, particularly hypoalgesia, than that of the younger ones. Post-stroke elderly in good functional conditions, such as normal muscle tone, better physical function and daily activities, and less joint pain, seems to have more equal pain sensitivity between both sides than those in poor conditions.

Thermography Sensor to Assess Motor and Sensitive Neuromuscular Sequels of Brain Damage

“…Some authors have observed, with clinical thermography and PTT, that acute inflammatory processes also increase pain sensitivity as the temperature increases [ 57 , 58 ], while in chronic pathologies, no correlation has been observed between the decrease in temperature and the decrease in pain sensitivity [ 59 ]. In patients with brain lesions, pain sensitivity is correlated to somatosensory abnormalities of the hypoalgesia type [ 60 ], in addition to thermal and sensory differences according to the level of spastic involvement. This author observed differences according to age, with older patients showing greater sensitivity to pain compared to younger patients, and the affected sides of elderly patients showing greater sensitivity than those of younger patients [ 60 ] In this regard, our results contrast with the data provided by these authors, since this clinical situation regarding thermal differences and PTT results was not observed.…”

“…In patients with brain lesions, pain sensitivity is correlated to somatosensory abnormalities of the hypoalgesia type [ 60 ], in addition to thermal and sensory differences according to the level of spastic involvement. This author observed differences according to age, with older patients showing greater sensitivity to pain compared to younger patients, and the affected sides of elderly patients showing greater sensitivity than those of younger patients [ 60 ] In this regard, our results contrast with the data provided by these authors, since this clinical situation regarding thermal differences and PTT results was not observed. This discrepancy in performance may be due to the degree of homogeneity of the lesion, which was much higher as all participants were hemiplegic patients, whereas in our study, we included several types of neurological sequelae.…”

The clinical effects and multimodal-fMRI of paired associative stimulation on wrist flexor spasticity after stroke

“…Denny-Brown [9] pointed out that the disruption of the anterior primary motor cortexM1 region, primary and secondary parietal sensory areas is necessary to induce PSS. The primary sensory cortexS1 and secondary sensory areas (such as prefrontal cortex and parietal lobe) are activated by peripheral sensory stimulation, which sensory network reorganization is bene cial to the relief of spasticity [12] .The ber connection between the cerebral sensory cortex and the motor cortex is destroyed after stroke, while somato-sensory stimulation can promote the reconstruction of the connection ber, then promote the recovery of motor function [13] .…”

Intrathecal Baclofen Infusion Pump for the Treatment of Painful Spastic Hemiplegia: A Case Report

“…The treatment of hemiplegia after a stroke is essential, and rehabilitation [6], as well as other interventions [7,8], offer interesting results on the motor skills of the affected muscle groups. However, the painful nature and the sensory alterations that accompany spastic hemiplegia continue to represent a therapeutic challenge that does not always reach goals [9], especially because the neuroplastic changes secondary to the pain syndrome complicate its treatment when they become chronic and are not treated promptly. Like all neuropathic pain, its treatment with anti-inflammatories is ineffective and prone to side effects.…”