Persistent shoulder pain after stroke

Shoulder pain is a common complication after stroke, but its etiology is poorly understood. Treatment is generally unsatisfactory and chronic pain is common. This thesis adopts a mechanism-based approach to the research of PSSP development. The primary objective of the thesis is to obtain a better understanding of the pathophysiological mechanisms responsible for the development of persistent PSSP (pPSSP). Chapter 2 introduces the terminology and the neurophysiological concepts of pain and describes the theoretical framework that is used in the subsequent chapters. Subsequently, 3 cross-sectional studies are described that assessed chronic stroke patients with pPSSP by using pain research tools such as quantitative sensory testing and conditioned pain modulation (Chapter 3), cortical evoked potentials (Chapter 4), and the neuropathic pain diagnostic questionnaire (Chapter 5). The last part of the thesis focuses on the longitudinal assessment of pPSSP within 2 weeks, at 3 months and at 6 months after stroke. Chapter 6 describes the assessment of the complete clinical picture of somatosensory, motor, cognitive, emotional and autonomic functions in patient developing pPSSP. In chapter 7 the relationship between pPSSP and somatosensory loss, somatosensory sensitization and endogenous pain inhibition is studied. In summary, pPSSP was associated with both somatosensory loss and somatosensory sensitization as well as with altered central somatosensory processing. Moreover, in the chronic phase after stroke many patients with pPSSP reported neuropathic-like pain complaints. The influence of the presumed initiating factors may gradually decrease during the persistence of PSSP. Pain perpetuation may be related to a vicious circle of pain, limited range of motion, re-injury and somatosensory sensitization which may establish quite rapidly (i.e. within 3 months after PSSP onset) and may persist into the chronic phase after stroke. These studies confirm the multi-factorial etiology of pPSSP. Ongoing nociception, the brain lesion itself, and other (premorbid) factors may contribute to the development of pPSSP. Although the precise neurophysiological mechanisms still remain unclear, these findings have important implications for the assessment, prevention and treatment of PSSP

Somatosensory and nociceptive changes in chronic post-stroke shoulder pain

Preliminary results from a cross-sectional study that investigated the relation between the presence of post-stroke shoulder pain and somatosensory and nociceptive changes are presented. The main finding is that both abnormal somatosensation and nociception are more frequently observed in stroke patients with pain as compared to pain-free stroke patients and healthy controls

Cortical processing of electrocutaneous stimuli in chronic stroke patients: a relationship with post-stroke shoulder pain.

Cerebral stroke is often associated with changes in cognitive-evaluative and somatosensory functions which may play a role in the development and maintenance of post-stroke pain

Bestuurkunde graag iets meer dan een universitaire managementleer

"De bloedsomloop is vergiftigd", riep Molm. En wij stelden ons ermee tevreden een pleister te plakken op elke plek van het aardoppervlak waar de ontstekingen zichtbaar worden. Kunnen we een bloedvergiftiging zó genezen? Nee, dat kunnen we niet. De patiënt gaat op een dag, van top tot teen met pleisters beplakt, kapot!&quot

Somatosensory abnormalities at baseline and follow-up in patients developing post-stroke shoulder pain

Post-stroke shoulder pain (PSSP) is traditionally regarded as a peripheral nociceptive pain. However, treatment aimed at peripheral pain mechanisms is often unsatisfactory and pain is persistent in a significant amount of patients. In addition, several signs of central sensitization (allodynia, generalized hyperalgesia) have been observed in patients with chronic PSSP, suggesting that central pain processing may be altered in these patients. To better understand the role of peripheral and central mechanisms in the development of PSSP we investigated pain complaints and somatosensory functions at baseline and two consecutive follow-up time frames

Task-dependent activation of distinct fast and slow(er) motor pathways during motor imagery

Background: Motor imagery and actual movements share overlapping activation of brain areas but little is known about task-specific activation of distinct motor pathways during mental simulation of movements. For real contractions, it was demonstrated that the slow(er) motor pathways are activated differently in ballistic compared to tonic contractions but it is unknown if this also holds true for imagined contractions.Objective: The aim of the present study was to assess the activity of fast and slow(er) motor pathways during mentally simulated movements of ballistic and tonic contractions.Methods: H-reflexes were conditioned with transcranial magnetic stimulation at different interstimulus intervals to assess the excitability of fast and slow(er) motor pathways during a) the execution of tonic and ballistic contractions, b) motor imagery of these contraction types, and c) at rest.Results: In contrast to the fast motor pathways, the slow(er) pathways displayed a task-specific activation: for imagined ballistic as well as real ballistic contractions, the activation was reduced compared to rest whereas enhanced activation was found for imagined tonic and real tonic contractions.Conclusions: This study provides evidence that the excitability of fast and slow(er) motor pathways during motor imagery resembles the activation pattern observed during real contractions. The findings indicate that motor imagery results in task- and pathway-specific subliminal activation of distinct subsets of neurons in the primary motor cortex

Properties of pain assessment tools for use in people living with stroke: systematic review

Replaced AM with VoR 2020-08-11.Background: Pain is a common problem after stroke and is associated with poor outcomes. There is no consensus on the optimal method of pain assessment in stroke. A review of the properties of tools should allow an evidence based approach to assessment. Objectives: We aimed to systematically review published data on pain assessment tools used in stroke, with particular focus on classical test properties of: validity, reliability, feasibility, responsiveness. Methods: We searched multiple, cross-disciplinary databases for studies evaluating properties of pain assessment tools used in stroke. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. We used a modified harvest plot to visually represent psychometric properties across tests. Results: The search yielded 12 relevant articles, describing 10 different tools (n=1106 participants). There was substantial heterogeneity and an overall high risk of bias. The most commonly assessed property was validity (eight studies) and responsiveness the least (one study). There were no studies with a neuropathic or headache focus. Included tools were either scales or questionnaires. The most commonly assessed tool was the Faces Pain Scale (FPS) (6 studies). The limited number of papers precluded meaningful meta-analysis at level of pain assessment tool or pain syndrome. Even where common data were available across papers, results were conflicting e.g. two papers described FPS as feasible and two described the scale as having feasibility issues. Conclusion: Robust data on the properties of pain assessment tools for stroke are limited. Our review highlights specific areas where evidence is lacking and could guide further research to identify the best tool(s) for assessing post-stroke pain. Improving feasibility of assessment in stroke survivors should be a future research target.https://doi.org/10.3389/fneur.2020.0079211pubpu