Demystifying post-stroke pain: from etiology to treatment
Pain following stroke is commonly reported but often incompletely managed, which prevents optimal recovery. This is in part due to the esoteric nature of post-stroke pain and its limited presence in current discussions of stroke management. The major specific afflictions that affect patients with stroke who develop pain include central post-stroke pain (CPSP), complex regional pain syndrome (CRPS), and pain associated with spasticity and shoulder subluxation. Each disorder carries its own intricacies that require specific approaches to treatment and understanding.
Publication date: Available online 6 September 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Rhian P. Lewis, Indre KriukelyteAbstractIn this article we discuss complex neuropathic pain states: diabetic peripheral neuropathic pain (DPNP), phantom limb pain (PLP), central post-stroke pain (CPSP), and complex regional pain syndrome (CRPS). Pain in these conditions can often be severe, significantly affect quality of life and be resistant to current treatment options. Multidisciplinary assessment and treatment is essential.
Discussion: Our findings indicate that the diagnostic validity of the current Budapest clinical criteria for PS-CRPS is low. Thus, the current Budapest criteria might not be appropriate for PS-CRPS diagnosis.
Conclusions: Acupuncture therapy seems effective for motor function, pain relief and activities of daily living in stroke patients with mild SHS, when it is used in combination with rehabilitation. The low certainty of evidence downgrades our confidence in making recommendations to clinical practice. Introduction Shoulder-hand syndrome (SHS) is a common condition among people who have had a stroke, with its reported prevalence ranging from 12% to 49% (1, 2). The main symptoms of SHS include pain, hyperalgesia, joint swelling and limitations in range of motion (ROM) (3). Post-stroke SHS is also named type I complex ...
Objective: To evaluate whether combining fluidotherapy to conventional rehabilitation program provides additional improvements on pain severity, upper extremity functions, and edema volume in patients with poststroke complex regional pain syndrome (CRPS). Design: Randomized controlled trial. Setting: Training and research hospital. Participants: Thirty hemiplegic patients with subacute stage CRPS type-1 of the upper extremity. Interventions: The patients randomly divided into 2 groups. Both groups received a 3 week conventional rehabilitation program (5days/week, 2-4 hours/day).
CONCLUSIONS: There are limited studies that have evaluated the cost-effectiveness of physiotherapy treatments in neurological disorders. Three studies that combined extra physiotherapy-by-physiotherapy assistant and novel interventions with conventional physiotherapy were found not cost-effective. Implications for Rehabilitation Progressive muscle strengthening exercise over a period of 6-month is reported to be cost-effective for falls prevention in people with Parkinson's disease Aerobic training is reported as potentially cost-effective for older adults with vascular cognitive impairment Physiotherapy given as an adjuva...
CONCLUSION: Following hemispheric stroke, the magnitude of low-beta ERD accompanying unilateral movement of the non-involved upper limb, and its hemispheric asymmetry, are both reduced by MVF. Low-beta ERD dynamics may serve as a marker of neurophysiological response to MVF in research aimed to elucidate the factors influencing patients' clinical gain from this treatment. PMID: 30194016 [PubMed - as supplied by publisher]
ConclusionFurther efforts are warranted to adapt neuromodulation/neurostimulation protocols per patient owing to neuroplastic changes that favor vs. hinder improvement of function. A sole solution for all cases is not suggested. An individualized approach relying on biomarkers and clinical outcomes should ease the implementation in clinical practice of noninvasive neuromodulation as an innovative therapeutic option to speed-up recovery towards gains beyond those already reached, thus to further improve the quality of life.
Authors: Sethy D, Sahoo S PMID: 29736085 [PubMed]
AbstractPurpose of ReviewTo describe the current understanding of the role of three-phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients.Recent FindingsCRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available...
Conditions: Dystonia; Complex Regional Pain Syndromes Intervention: Sponsor: National Institute of Neurological Disorders and Stroke (NINDS) Not yet recruiting - verified July 7, 2017