Abstract
Chronic pain after stroke is a common, yet often overlooked sequela of cerebrovascular injury. Among the syndromes seen in post-stroke pain (PSP) are central post-stroke pain (CPSP) and complex regional pain syndrome (CRPS). Shoulder pain develops in a large subset of patients with residual upper-extremity weakness. Shoulder pain after stroke is multifactorial. Treatment of pain in these patients can be challenging when the exact etiology is unclear, and may necessitate multiple, successive therapeutic approaches before an effective remedy is found. Here we present a case of Post-Stroke Shoulder Pain of multifactorial etiology in which multiple treatment strategies were utilized, including successful trial of a cervical spinal cord stimulator (SCS) device.
Highlights
Craniotomies in the pediatric population is a common surgical procedure owing to the high incidence of central nervous system (CNS) tumors in children [1] and an increase in the cases of pediatric traumatic brain injuries [2] requiring surgical management
There is a paucity of randomized controlled trials involving pediatric patients, the interventions assessed in this review are variable
This review cannot provide specific recommendations on systemic pharmacologic treatment due to significant variability in methodology and standardization of data collection of the studies included in the review
Summary
Craniotomies in the pediatric population is a common surgical procedure owing to the high incidence of central nervous system (CNS) tumors in children [1] and an increase in the cases of pediatric traumatic brain injuries [2] requiring surgical management. Craniotomies were assumed to have mild to moderate postoperative pain [3], pain assessment on post-craniotomy patients has been subjected to limited research especially in pediatric patients [4]. Several recent studies suggest that moderate to severe pain in the first 24 to 48 hours postoperatively may be higher than previously expected [5], and postoperative pain following intracranial surgery is more significant than initially reported, with as many as 87% of patients reporting moderate to severe pain in the first 24 hours post-procedure [6,7]. Post-craniotomy pain is predominantly superficial, suggesting somatic origin [8] originating from the scalp, muscles, and soft tissue, with subsequent activation of the pain pathway from manipulation of the dura mater [9]. There are different approaches to analgesia following craniotomy and cranioplasty, but there is limited consensus on postcraniotomy pain management especially in the pediatric population
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