Abstract
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.
Highlights
We have recently shown that spasticity causes velocity-dependent hypertonia, and another upper motor neuron syndrome (UMNS) phenomenon called spastic dystonia [3,4,5]
From 1 January 2021 to 31 July 2021, 41 post-stroke patients with upper limb spastic dystonia referred to our outpatient clinic
This study aimed to investigate pain in stroke survivors manifesting upper limb spastic dystonia
Summary
We have recently shown that spasticity causes velocity-dependent hypertonia, and another UMNS phenomenon called spastic dystonia [3,4,5]. Spastic dystonia is not a pathological stretch reflex. It refers to the inability to voluntary silence muscle activity on command [7,8]. This inability leads to spontaneous tonic contractions that are stretch sensitive and produce pathological limb postures [9]. Overall, both spasticity and spastic dystonia manifest clinically with velocity-dependent hypertonia, but only spastic dystonia manifests with pathological resting postures [10]
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