Efficacy of methylprednisolone versus other pharmacologic interventions for the treatment of central post-stroke pain: a retrospective analysis

Abstract

Anthony J Pellicane, Scott R Millis Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Rehabilitation Institute of Michigan in the Detroit Medical Center, Detroit, MI, USA Purpose: To determine if an oral, tapered methylprednisolone regimen is superior to other commonly used pharmacologic interventions for the treatment of central post-stroke pain (CPSP). Patients and methods: In this study, the charts of 146 stroke patients admitted to acute inpatient rehabilitation were retrospectively reviewed. Patients diagnosed with CPSP underwent further chart review to assess numerical rating scale for pain scores and as-needed pain medication usage at different time points comparing CPSP patients treated with methylprednisolone to those treated with other pharmacologic interventions. Results: In the sample, 8.2% were diagnosed with CPSP during acute care or inpatient rehabilitation. Mean numerical rating scale for pain scores day of symptom onset did not differ between those patients treated with methylprednisolone versus those treated with other pharmacologic interventions (mean ± standard deviation; 6.1 ± 2.3 versus 5.7 ± 1.6, P = 0.77). However, mean numerical rating scale for pain scores differed significantly 1-day after treatment initiation (1.7 ± 2.1 versus 5.0 ± 1.9, P = 0.03) and 1-day prior to rehabilitation discharge (0.3 ± 0.9 versus 4.1 ± 3.2, P = 0.01) between the two groups. Compared to day of symptom onset, as-needed pain medication usage within the methylprednisolone group was marginally less 1-day after treatment initiation (Z = -1.73, P = 0.08) and 1-day prior to rehabilitation discharge (Z = -1.89, P = 0.06). No difference in as-needed pain medication usage existed within the non-steroid group at the same time points. Conclusion: Methylprednisolone is a potential therapeutic option for CPSP. The findings herein warrant study in prospective trials. Keywords: stroke, pain, central post-stroke pain, complex regional pain syndromes, therapeutics, neuralgi