Updates in the Treatment of Post-Stroke Pain

Plecash, Alyson; Chebini, Amokrane; Ip, Alvin; Lai, Joshua; Mattar, Andrew A. G.; Randhawa, Jason; Field, Thalia S.

doi:10.1007/s11910-019-1003-2

Cited by 20 publications

(13 citation statements)

References 122 publications

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“…Another study involving 51 stroke survivors showed that tactile and proprioceptive impairments were observed in 47 and 49% of patients’ affected side, respectively, whereas impaired tactility and proprioception were observed in 16 and 20% of patients’ unaffected side, respectively ( Carey and Matyas, 2011 ). Considering that pain is another frequent symptom following stroke ( Lundstrom et al, 2009 ; Plecash et al, 2019 ), several studies have reported patients’ sensory condition for pain stimuli with stroke through various tests, including thermal, electrical, and mechanical stimuli ( Roosink et al, 2011 ; Soo Hoo et al, 2013 ; Zeilig et al, 2013 ; Lindgren et al, 2014 ). According to Maier et al (2010) , mechanical sensory abnormalities were more frequent in patients with neuropathic pain, particularly hyperalgesia for blunt pressure, and either mechanical hyperalgesia or hypoalgesia are existing in painful patients with a central nervous injury.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

Zhang

Wang

et al. 2021

Front. Neurosci.

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BackgroundSomatosensory impairments and pain are common symptoms following stroke. However, the condition of perception and pain threshold for pressure stimuli and the factors that can influence this in individuals with stroke are still unclear. This study aimed to investigate the gender differences in pressure pain threshold (PPT) and positive somatosensory signs for pressure stimuli, and explore the effects of joint pain, motor function, and activities of daily living (ADL) on pain threshold in post-stroke patients.DesignA cross-sectional study.MethodsA total of 60 participants with stroke were recruited, and their pain condition, motor functions, and ADL were evaluated by the Fugl-Meyer assessment of joint pain scale, motor function scale, and Barthel index, respectively. PPTs in eight tested points at the affected and unaffected sides were assessed.ResultsSignificant differences in PPTs were found between male and female patients in all measured muscles (p < 0.05). Positive somatosensory signs for pressure stimuli, including hypoalgesia and hyperalgesia, were frequently found at the affected side, particularly in the extremity muscles, but such signs were not significantly influenced by gender (p > 0.05). More equal PPTs between both sides and relatively lower PPTs at the affected side in the trunk and medial gastrocnemius muscles (p < 0.05) were observed in patients with less pain, better motor functions, and ADL.ConclusionGender differences widely exist in post-stroke survivors either at the affected or unaffected side, which are multifactorial. Sensory loss and central and/or peripheral sensitization, such as hypoalgesia and hyperalgesia for pressure stimuli, caused by a brain lesion are common signs in male and female stroke patients. Moreover, patients who are in a better condition show a more symmetrical pain sensitivity between both sides in the trunk and in female lower extremities, indicating the bidirectional improvement of somatosensory abnormalities caused by a possible neural plasticity.

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Section: Introductionmentioning

confidence: 99%

The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

Zhang

Wang

et al. 2021

Front. Neurosci.

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“…Dennoch kann eine Off-label-Therapie laut S2k-Leitlinien in Einzelfällen im Rahmen eines multimodalen Schmerztherapiekonzeptes in Erwägung gezogen werden, wenn andere Schmerztherapien versagen. [41,42]. Bereits diese Diskrepanz zwischen den Angaben spiegelt gut wider, dass diese Entität nur unzureichend untersucht, diagnostiziert und therapiert wird.…”

Section: Cannabinoideunclassified

Diagnostik und Therapie neuropathischer Schmerzen

Fabig¹,

Kersebaum²,

Sendel³

et al. 2021

Nervenheilkunde

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ZUSAMMENFASSUNGDie Ätiologie neuropathischer Schmerzen gründet auf einer Schädigung des somatosensorischen Systems. Sie unterscheiden sich von nozizeptiven Schmerzen, bei welchen das somatosensorische System intakt ist, nicht nur in ihrer Schmerzqualität, sondern auch in ihrer Therapie. Periphere neuropathische Schmerzen, beispielsweise aufgrund einer Polyneuropathie, werden von zentralen neuropathischen Schmerzen, beispielsweise als Folge eines Schlaganfalls abgegrenzt. Bei der Diagnostik neuropathischer Schmerzen, wird zwischen „sicheren“, „wahrscheinlichen“, „möglichen“ und „unwahrscheinlichen“ neuropathischen Schmerzen unterschieden. Eine gründliche Anamnese, welche durch Fragebögen ergänzt werden kann, und körperliche Untersuchung sind bei der Diagnostik erforderlich. Zum Erkennen der „Positiv“- und „Negativsymptome“, welche für neuropathische Schmerzen charakteristisch sind, kann man sich einfacher „Bedside-Tools“ bedienen. Für die Sicherung der Diagnose können die Quantitative Sensorische Testung (QST), Methoden der Bildgebung und der klassischen Elektrophysiologie sowie die Hautbiopsie und weitere spezialisierte Methoden eingesetzt werden. Das Ansprechen neuropathischer Schmerzen auf klassische Analgetika ist in der Regel schlecht. Daher werden als Medikamente erster Wahl Antikonvulsiva und Antidepressiva eingesetzt. Auch topisch applizierte Substanzen wie Capsaicin oder Lidocain und niedrigpotente Opioide finden in der Therapie neuropathischer Schmerzen häufig ihre Anwendung. Oft ist eine Kombination mehrerer Substanzen erforderlich. Die Trigeminusneuralgie sowie der zentrale Schmerz nach Schlaganfall oder bei Multipler Sklerose weisen Besonderheiten in ihrer Diagnostik und Therapie auf, welchen in Exkursen Aufmerksamkeit gewidmet werden soll.

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“…Muscle hypertonia is a risk factor for pain after stroke [14] and botulinum toxin-A (BoNT-A) proved an effective treatment for both hypertonia and pain [15]. Notwithstanding the number of studies, it has recently been highlighted that the existing literature on post-stroke pain is frequently challenging to interpret due to the methodological limitations of the studies and the in-homogeneity of participants [16]. This challenge fits particularly well with studies investigating pain in patients with increased muscle tone.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

Trompetto

Marinelli

Mori

et al. 2022

Toxins

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This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints.

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Updates in the Treatment of Post-Stroke Pain

Cited by 20 publications

References 122 publications

The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

Diagnostik und Therapie neuropathischer Schmerzen

Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

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