Treatment of Post-Stroke Shoulder Pain of Multi-Factorial Etiology

Kaufman Andrew G,Kloepping Carolyn,Gaballa Mina,Wayne Robert,Channagiri Varun,Hannaford Stephen,Guider James,Calvert Timothy

doi:10.36959/377/350

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

Individuals who suffer a stroke are at risk for the development of chronic pain syndromes, with prevalence of up to 50% [1]
Given that central post-stroke pain (CPSP) and complex regional pain syndrome (CRPS) have many similar features, it can be difficult to distinguish between the two. This is further confounded by the fact that both syndromes can appear together, and are both associated with shoulder pain
There is a notable lack of class I and II studies investigating treatment for CPSP

Summary

Introduction

Individuals who suffer a stroke are at risk for the development of chronic pain syndromes, with prevalence of up to 50% [1]. As subluxation is more common in stroke patients who develop CRPS, and the severity of weakness and immobility in the shoulder are related to the likelihood of developing CRPS, glenohumeral joint instability and biomechanical impairment are likely implicated in post-stroke CRPS [10,11,12]. These etiologies of post-stoke pain each have unique treatment strategies, and the integration of those strategies can make care of the patient with multi-factorial post-stroke shoulder pain quite challenging

Case Presentation

Findings

Discussion