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Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome.

de Oliveira RA, de Andrade DC, Machado AG, Teixeira MJ - BMC Neurol (2012)

Bottom Line: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult.No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores.Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.

ABSTRACT

Background: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients.

Methods: CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants.

Results: Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores.

Conclusions: The presence of MPS is not an exception after stroke and may present in association with CPSP as a common comorbid condition. Further studies are necessary to clarify the role of MPS in CPSP.

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Related in: MedlinePlus

Pain area, thermal deficits and miofascial pain syndrome trigger points in central poststroke pain patients. Areas of pain (red), thermo-sensory abnormalities (yellow) and myofascial pain trigger points ( + ) in 40 patients with central poststroke pain.
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Figure 1: Pain area, thermal deficits and miofascial pain syndrome trigger points in central poststroke pain patients. Areas of pain (red), thermo-sensory abnormalities (yellow) and myofascial pain trigger points ( + ) in 40 patients with central poststroke pain.

Mentions: Bedside physical examination was performed with the following tests: vibration detection threshold was performed with a 128 Hz vibrating tuning fork applied to the first finger and to the toe bilaterally. Thresholds were defined as the time elapsed from the beginning of the exam to the point where the patients ceased to detect the vibration stimulus. Hyperalgesia was assessed with a pinprick. Mechanical dynamic allodynia was assessed with a soft brush slightly stroke for 6 cm 2 cm/sec. Tactile non-painful stimulus was investigated with a cotton swab. Thermal sensitivity was assessed with hot (40-45°C) and cold (5-10°C) water-filled tubes. Thermal allodynia was defined as the presence of pain to the contact of a glass tube containing water at 20°C in the absence of mechanical allodynia. Each sensory test was performed in predetermined cutaneous points five centimeters apart from each other from the face to the feet bilaterally[20,21] (Figure 1). MPS was searched for in a systematic manner by gentle manual palpation of predefined muscles trigger points. When palpation elicited the characteristic regional referred pain from the muscle being tested, trigger points were considered as active and MPS was defined after the other diagnostic criteria were fulfilled[15,16]. The main muscles evaluated for MPS in CPSP patients were defined according to a pilot study previously performed in a similar group of patients. The location of the active trigger points, the extension of sensory deficit and the location of pain was marked and a human body template by the examiner.


Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome.

de Oliveira RA, de Andrade DC, Machado AG, Teixeira MJ - BMC Neurol (2012)

Pain area, thermal deficits and miofascial pain syndrome trigger points in central poststroke pain patients. Areas of pain (red), thermo-sensory abnormalities (yellow) and myofascial pain trigger points ( + ) in 40 patients with central poststroke pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475118&req=5

Figure 1: Pain area, thermal deficits and miofascial pain syndrome trigger points in central poststroke pain patients. Areas of pain (red), thermo-sensory abnormalities (yellow) and myofascial pain trigger points ( + ) in 40 patients with central poststroke pain.
Mentions: Bedside physical examination was performed with the following tests: vibration detection threshold was performed with a 128 Hz vibrating tuning fork applied to the first finger and to the toe bilaterally. Thresholds were defined as the time elapsed from the beginning of the exam to the point where the patients ceased to detect the vibration stimulus. Hyperalgesia was assessed with a pinprick. Mechanical dynamic allodynia was assessed with a soft brush slightly stroke for 6 cm 2 cm/sec. Tactile non-painful stimulus was investigated with a cotton swab. Thermal sensitivity was assessed with hot (40-45°C) and cold (5-10°C) water-filled tubes. Thermal allodynia was defined as the presence of pain to the contact of a glass tube containing water at 20°C in the absence of mechanical allodynia. Each sensory test was performed in predetermined cutaneous points five centimeters apart from each other from the face to the feet bilaterally[20,21] (Figure 1). MPS was searched for in a systematic manner by gentle manual palpation of predefined muscles trigger points. When palpation elicited the characteristic regional referred pain from the muscle being tested, trigger points were considered as active and MPS was defined after the other diagnostic criteria were fulfilled[15,16]. The main muscles evaluated for MPS in CPSP patients were defined according to a pilot study previously performed in a similar group of patients. The location of the active trigger points, the extension of sensory deficit and the location of pain was marked and a human body template by the examiner.

Bottom Line: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult.No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores.Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.

ABSTRACT

Background: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients.

Methods: CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants.

Results: Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores.

Conclusions: The presence of MPS is not an exception after stroke and may present in association with CPSP as a common comorbid condition. Further studies are necessary to clarify the role of MPS in CPSP.

Show MeSH
Related in: MedlinePlus