Semin Neurol 2021; 41(01): 067-074
DOI: 10.1055/s-0040-1722641
Review Article

Poststroke Pain

Seoyon Yang
1   Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Korea
,
Min Cheol Chang
2   Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
› Author Affiliations
Funding The present study was supported by a National Research Foundation of Korea grand funded by the Korean government (grant no. NRF-2019M3E5D1A02068106).

Abstract

Pain is common but often underrecognized after stroke. Poststroke pain (PSP) hinders recovery, impairs quality of life, and is associated with the psychological state of patients with stroke. The most common subtypes of PSP include central PSP, complex regional pain syndrome, shoulder pain, spasticity-related pain, and headache. The pathophysiologies of these PSP subtypes are not yet clearly understood, and PSP is refractory to conventional treatment in many patients. However, recent studies have proposed potential pathophysiologies of PSP subtypes, which may help prioritize therapies that target specific mechanisms.

Disclosure

The authors have no conflicts of interest to report.




Publication History

Article published online:
14 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Choi-Kwon S, Choi SH, Suh M. et al. Musculoskeletal and central pain at 1 year post-stroke: associated factors and impact on quality of life. Acta Neurol Scand 2017; 135 (04) 419-425
  • 2 Paolucci S, Iosa M, Toni D. et al; Neuropathic Pain Special Interest Group of the Italian Neurological Society. Prevalence and time course of post-stroke pain: a multicenter prospective hospital-based study. Pain Med 2016; 17 (05) 924-930
  • 3 Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the Bergen Stroke Study. Vasc Health Risk Manag 2012; 8: 407-413
  • 4 O'Donnell MJ, Diener HC, Sacco RL, Panju AA, Vinisko R, Yusuf S. PRoFESS Investigators. Chronic pain syndromes after ischemic stroke: PRoFESS trial. Stroke 2013; 44 (05) 1238-1243
  • 5 Chang MC. The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke. Int J Neurosci 2017; 127 (11) 958-964
  • 6 Lundström E, Smits A, Terént A, Borg J. Risk factors for stroke-related pain 1 year after first-ever stroke. Eur J Neurol 2009; 16 (02) 188-193
  • 7 Treister AK, Hatch MN, Cramer SC, Chang EY. Demystifying poststroke pain: from etiology to treatment. PM R 2017; 9 (01) 63-75
  • 8 Delpont B, Blanc C, Osseby GV, Hervieu-Bègue M, Giroud M, Béjot Y. Pain after stroke: a review. Rev Neurol (Paris) 2018; 174 (10) 671-674
  • 9 Henry JL, Lalloo C, Yashpal K. Central poststroke pain: an abstruse outcome. Pain Res Manag 2008; 13 (01) 41-49
  • 10 Klit H, Finnerup NB, Jensen TS. Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009; 8 (09) 857-868
  • 11 Hansen AP, Marcussen NS, Klit H, Andersen G, Finnerup NB, Jensen TS. Pain following stroke: a prospective study. Eur J Pain 2012; 16 (08) 1128-1136
  • 12 Klit H, Finnerup NB, Andersen G, Jensen TS. Central poststroke pain: a population-based study. Pain 2011; 152 (04) 818-824
  • 13 de Oliveira RA, de Andrade DC, Machado AG, Teixeira MJ. Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome. BMC Neurol 2012; 12: 89
  • 14 Kumar B, Kalita J, Kumar G, Misra UK. Central poststroke pain: a review of pathophysiology and treatment. Anesth Analg 2009; 108 (05) 1645-1657
  • 15 Lin CH, Chen KH, Chang CH. et al. Muscle pain intensity and pressure pain threshold changes in different periods of stroke patients. Am J Phys Med Rehabil 2014; 93 (04) 299-309
  • 16 Greenspan JD, Ohara S, Sarlani E, Lenz FA. Allodynia in patients with post-stroke central pain (CPSP) studied by statistical quantitative sensory testing within individuals. Pain 2004; 109 (03) 357-366
  • 17 Castel A, Hélie P, Beaudry F, Vachon P. Bilateral central pain sensitization in rats following a unilateral thalamic lesion may be treated with high doses of ketamine. BMC Vet Res 2013; 9: 59
  • 18 Kalita J, Kumar B, Misra UK, Pradhan PK. Central post stroke pain: clinical, MRI, and SPECT correlation. Pain Med 2011; 12 (02) 282-288
  • 19 Landerholm ÅH, Hansson PT. Mechanisms of dynamic mechanical allodynia and dysesthesia in patients with peripheral and central neuropathic pain. Eur J Pain 2011; 15 (05) 498-503
  • 20 Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995; 61 (02) 187-193
  • 21 Kong KH, Woon VC, Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors. Arch Phys Med Rehabil 2004; 85 (01) 35-40
  • 22 Hong JH, Choi BY, Chang CH. et al. The prevalence of central poststroke pain according to the integrity of the spino-thalamo-cortical pathway. Eur Neurol 2012; 67 (01) 12-17
  • 23 Kim JS. Pure sensory stroke. Clinical-radiological correlates of 21 cases. Stroke 1992; 23 (07) 983-987
  • 24 Vestergaard K, Nielsen J, Andersen G, Ingeman-Nielsen M, Arendt-Nielsen L, Jensen TS. Sensory abnormalities in consecutive, unselected patients with central post-stroke pain. Pain 1995; 61 (02) 177-186
  • 25 Wasner G, Lee BB, Engel S, McLachlan E. Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain 2008; 131 (Pt 9): 2387-2400
  • 26 Head H, Holmes G. Sensory disturbances from cerebral lesions. Brain 1911; 34: 102-254
  • 27 Neto FL, Ferreira-Gomes J, Castro-Lopes JM. Distribution of GABA receptors in the thalamus and their involvement in nociception. Adv Pharmacol 2006; 54: 29-51
  • 28 Pattany PM, Yezierski RP, Widerström-Noga EG. et al. Proton magnetic resonance spectroscopy of the thalamus in patients with chronic neuropathic pain after spinal cord injury. AJNR Am J Neuroradiol 2002; 23 (06) 901-905
  • 29 Ralston III HJ. Pain and the primate thalamus. Prog Brain Res 2005; 149: 1-10
  • 30 Zhao P, Waxman SG, Hains BC. Modulation of thalamic nociceptive processing after spinal cord injury through remote activation of thalamic microglia by cysteine–cysteine chemokine ligand 21. J Neurosci 2007; 27 (33) 8893-8902
  • 31 Jungehulsing GJ, Israel H, Safar N. et al. Levetiracetam in patients with central neuropathic post-stroke pain--a randomized, double-blind, placebo-controlled trial. Eur J Neurol 2013; 20 (02) 331-337
  • 32 Pellicane AJ, Millis SR. Efficacy of methylprednisolone versus other pharmacologic interventions for the treatment of central post-stroke pain: a retrospective analysis. J Pain Res 2013; 6: 557-563
  • 33 Widar M, Samuelsson L, Karlsson-Tivenius S, Ahlström G. Long-term pain conditions after a stroke. J Rehabil Med 2002; 34 (04) 165-170
  • 34 Dworkin RH, O'Connor AB, Backonja M. et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007; 132 (03) 237-251
  • 35 Attal N, Gaudé V, Brasseur L. et al. Intravenous lidocaine in central pain: a double-blind, placebo-controlled, psychophysical study. Neurology 2000; 54 (03) 564-574
  • 36 Canavero S, Bonicalzi V. Intravenous subhypnotic propofol in central pain: a double-blind, placebo-controlled, crossover study. Clin Neuropharmacol 2004; 27 (04) 182-186
  • 37 Saitoh Y, Yoshimine T. Stimulation of primary motor cortex for intractable deafferentation pain. Acta Neurochir Suppl (Wien) 2007; 97 (Pt 2): 51-56
  • 38 Sokal P, Harat M, Zieliński P, Furtak J, Paczkowski D, Rusinek M. Motor cortex stimulation in patients with chronic central pain. Adv Clin Exp Med 2015; 24 (02) 289-296
  • 39 Choi GS, Kwak SG, Lee HD, Chang MC. Effect of high-frequency repetitive transcranial magnetic stimulation on chronic central pain after mild traumatic brain injury: a pilot study. J Rehabil Med 2018; 50 (03) 246-252
  • 40 Gu SY, Chang MC. The effects of 10-Hz repetitive transcranial magnetic stimulation on depression in chronic stroke patients. Brain Stimul 2017; 10 (02) 270-274
  • 41 Kobayashi M, Fujimaki T, Mihara B, Ohira T. Repetitive transcranial magnetic stimulation once a week induces sustainable long-term relief of central poststroke pain. Neuromodulation 2015; 18 (04) 249-254
  • 42 Oh HM, Kim CH, Kim AR. Dramatic effect in passive ROM exercise under sedation in a patient with intractable complex regional pain syndrome (type I): a case report. Medicine (Baltimore) 2019; 98 (13) e14990
  • 43 Kim H, Lee CH, Kim SH, Kim YD. Epidemiology of complex regional pain syndrome in Korea: an electronic population health data study. PLoS One 2018; 13 (06) e0198147
  • 44 Kocabas H, Levendoglu F, Ozerbil OM, Yuruten B. Complex regional pain syndrome in stroke patients. Int J Rehabil Res 2007; 30 (01) 33-38
  • 45 McLean DE. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil 2004; 85 (03) 466-469
  • 46 Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007; 8 (04) 326-331
  • 47 Kwon HW, Paeng JC, Nahm FS. et al. Diagnostic performance of three-phase bone scan for complex regional pain syndrome type 1 with optimally modified image criteria. Nucl Med Mol Imaging 2011; 45 (04) 261-267
  • 48 Nahm FS. Infrared thermography in pain medicine. Korean J Pain 2013; 26 (03) 219-222
  • 49 Wüppenhorst N, Maier C, Frettlöh J, Pennekamp W, Nicolas V. Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity. Clin J Pain 2010; 26 (03) 182-189
  • 50 Coderre TJ, Bennett GJ. A hypothesis for the cause of complex regional pain syndrome-type I (reflex sympathetic dystrophy): pain due to deep-tissue microvascular pathology. Pain Med 2010; 11 (08) 1224-1238
  • 51 Datta R, Agrawal J, Sharma A, Rathore VS, Datta S. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body. J Anaesthesiol Clin Pharmacol 2017; 33 (04) 534-540
  • 52 Dev S, Yoo Y, Lee HJ, Kim DH, Kim YC, Moon JY. Does temperature increase by sympathetic neurolysis improve pain in complex regional pain syndrome? A retrospective cohort study. World Neurosurg 2018; 109: e783-e791
  • 53 Kim ED, Yoo WJ, Kim YN, Park HJ. Ultrasound-guided pulsed radiofrequency treatment of the cervical sympathetic chain for complex regional pain syndrome: a retrospective observational study. Medicine (Baltimore) 2017; 96 (01) e5856
  • 54 Sebastin SJ. Complex regional pain syndrome. Indian J Plast Surg 2011; 44 (02) 298-307
  • 55 Koban M, Leis S, Schultze-Mosgau S, Birklein F. Tissue hypoxia in complex regional pain syndrome. Pain 2003; 104 (1-2): 149-157
  • 56 Okudan B, Celik C. Determination of inflammation of reflex sympathetic dystrophy at early stages with Tc-99m HIG scintigraphy: preliminary results. Rheumatol Int 2006; 26 (05) 404-408
  • 57 Schinkel C, Gaertner A, Zaspel J, Zedler S, Faist E, Schuermann M. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clin J Pain 2006; 22 (03) 235-239
  • 58 Winston P. Early treatment of acute complex regional pain syndrome after fracture or injury with prednisone: Why is there a failure to treat? A case series. Pain Res Manag 2016; 2016: 7019196
  • 59 Palmer G. Complex regional pain syndrome. Aust Prescr 2015; 38 (03) 82-86
  • 60 Harke H, Gretenkort P, Ladleif HU, Rahman S, Harke O. The response of neuropathic pain and pain in complex regional pain syndrome I to carbamazepine and sustained-release morphine in patients pretreated with spinal cord stimulation: a double-blinded randomized study. Anesth Analg 2001; 92 (02) 488-495
  • 61 Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997; 73 (02) 123-139
  • 62 van de Vusse AC, Stomp-van den Berg SG, Kessels AH, Weber WE. Randomised controlled trial of gabapentin in complex regional pain syndrome type 1 [ISRCTN84121379]. BMC Neurol 2004; 4: 13
  • 63 Atalay NS, Ercidogan O, Akkaya N, Sahin F. Prednisolone in complex regional pain syndrome. Pain Physician 2014; 17 (02) 179-185
  • 64 Visnjevac O, Costandi S, Patel BA. et al. A comprehensive outcome-specific review of the use of spinal cord stimulation for complex regional pain syndrome. Pain Pract 2017; 17 (04) 533-545
  • 65 Goh EL, Chidambaram S, Ma D. Complex regional pain syndrome: a recent update. Burns Trauma 2017; 5: 2
  • 66 Ward AB. Hemiplegic shoulder pain. J Neurol Neurosurg Psychiatry 2007; 78 (08) 789
  • 67 Dromerick AW, Reding MJ. Functional outcome for patients with hemiparesis, hemihypesthesia, and hemianopsia. Does lesion location matter?. Stroke 1995; 26 (11) 2023-2026
  • 68 Gamble GE, Barberan E, Laasch HU, Bowsher D, Tyrrell PJ, Jones AK. Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. Eur J Pain 2002; 6 (06) 467-474
  • 69 Rajaratnam BS, Venketasubramanian N, Kumar PV, Goh JC, Chan YH. Predictability of simple clinical tests to identify shoulder pain after stroke. Arch Phys Med Rehabil 2007; 88 (08) 1016-1021
  • 70 Choi GS, Chang MC. Effects of high-frequency repetitive transcranial magnetic stimulation on reducing hemiplegic shoulder pain in patients with chronic stoke: a randomized controlled trial. Int J Neurosci 2018; 128 (02) 110-116
  • 71 Pong YP, Wang LY, Huang YC, Leong CP, Liaw MY, Chen HY. Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study. J Rehabil Med 2012; 44 (07) 553-557
  • 72 Precerutti M, Garioni E, Madonia L, Draghi F. US anatomy of the shoulder: pictorial essay. J Ultrasound 2010; 13 (04) 179-187
  • 73 Faghri PD, Rodgers MM, Glaser RM, Bors JG, Ho C, Akuthota P. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil 1994; 75 (01) 73-79
  • 74 Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis 2015; 39 (3-4): 190-201
  • 75 Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am 2014; 25 (02) 411-437
  • 76 van Bladel A, Lambrecht G, Oostra KM, Vanderstraeten G, Cambier D. A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients. Eur J Phys Rehabil Med 2017; 53 (03) 400-409
  • 77 Stolzenberg D, Siu G, Cruz E. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil 2012; 19 (05) 444-456
  • 78 McCollough III NC. The role of the orthopedic surgeon in the treatment of stroke. Orthop Clin North Am 1978; 9 (02) 305-324
  • 79 Linn SL, Granat MH, Lees KR. Prevention of shoulder subluxation after stroke with electrical stimulation. Stroke 1999; 30 (05) 963-968
  • 80 Wilson RD, Chae J. Hemiplegic shoulder pain. Phys Med Rehabil Clin N Am 2015; 26 (04) 641-655
  • 81 Lim JY, Koh JH, Paik NJ. Intramuscular botulinum toxin-A reduces hemiplegic shoulder pain: a randomized, double-blind, comparative study versus intraarticular triamcinolone acetonide. Stroke 2008; 39 (01) 126-131
  • 82 Marciniak CM, Harvey RL, Gagnon CM. et al. Does botulinum toxin type A decrease pain and lessen disability in hemiplegic survivors of stroke with shoulder pain and spasticity?: a randomized, double-blind, placebo-controlled trial. Am J Phys Med Rehabil 2012; 91 (12) 1007-1019
  • 83 Marco E, Duarte E, Vila J. et al. Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial. J Rehabil Med 2007; 39 (06) 440-447
  • 84 Zhou M, Li F, Lu W, Wu J, Pei S. Efficiency of neuromuscular electrical stimulation and transcutaneous nerve stimulation on hemiplegic shoulder pain: a randomized controlled trial. Arch Phys Med Rehabil 2018; 99 (09) 1730-1739
  • 85 Walsh K. Management of shoulder pain in patients with stroke. Postgrad Med J 2001; 77 (912) 645-649
  • 86 Kim EH, Chang MC, Seo JP, Jang SH, Song JC, Jo HM. The effect of a hand-stretching device during the management of spasticity in chronic hemiparetic stroke patients. Ann Rehabil Med 2013; 37 (02) 235-240
  • 87 Francisco GE, McGuire JR. Poststroke spasticity management. Stroke 2012; 43 (11) 3132-3136
  • 88 Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol 2010; 257 (07) 1067-1072
  • 89 Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. Muscle Nerve Suppl 1997; 6: S1-S13
  • 90 Chang MC. Reduced foot pain after spasticity control with alcohol block in a patient with chronic hemiparetic stroke: a case report. J Phys Ther Sci 2017; 29 (04) 767-770
  • 91 Chang MC. Metatarsalgia in a patient with chronic hemiparetic stroke managed with alcohol block of the tibial nerve: a case report. Neurol Asia 2017; 22 (03) 267-270
  • 92 Bakheit AM. The pharmacological management of post-stroke muscle spasticity. Drugs Aging 2012; 29 (12) 941-947
  • 93 Santamato A, Cinone N, Panza F. et al. Botulinum toxin type A for the treatment of lower limb spasticity after stroke. Drugs 2019; 79 (02) 143-160
  • 94 Arboix A, Massons J, Oliveres M, Arribas MP, Titus F. Headache in acute cerebrovascular disease: a prospective clinical study in 240 patients. Cephalalgia 1994; 14 (01) 37-40
  • 95 Ferro JM, Melo TP, Oliveira V. et al. A multivariate study of headache associated with ischemic stroke. Headache 1995; 35 (06) 315-319
  • 96 Koudstaal PJ, van Gijn J, Kappelle LJ. Dutch TIA Study Group. Headache in transient or permanent cerebral ischemia. Stroke 1991; 22 (06) 754-759
  • 97 Vestergaard K, Andersen G, Nielsen MI, Jensen TS. Headache in stroke. Stroke 1993; 24 (11) 1621-1624
  • 98 Hansen AP, Marcussen NS, Klit H, Kasch H, Jensen TS, Finnerup NB. Development of persistent headache following stroke: a 3-year follow-up. Cephalalgia 2015; 35 (05) 399-409
  • 99 Ferro JM, Melo TP, Guerreiro M. Headaches in intracerebral hemorrhage survivors. Neurology 1998; 50 (01) 203-207
  • 100 Klit H, Finnerup NB, Overvad K, Andersen G, Jensen TS. Pain following stroke: a population-based follow-up study. PLoS One 2011; 6 (11) e27607
  • 101 Evans RW, Mitsias PD. Headache at onset of acute cerebral ischemia. Headache 2009; 49 (06) 902-908
  • 102 Mitsias P, Ramadan NM. Headache in ischemic cerebrovascular disease. Part II: Mechanisms and predictive value. Cephalalgia 1992; 12 (06) 341-344
  • 103 Kim JH, Suh SI, Seol HY. et al. Regional grey matter changes in patients with migraine: a voxel-based morphometry study. Cephalalgia 2008; 28 (06) 598-604
  • 104 Schmidt-Wilcke T, Leinisch E, Straube A. et al. Gray matter decrease in patients with chronic tension type headache. Neurology 2005; 65 (09) 1483-1486
  • 105 Lai J, Harrison RA, Plecash A, Field TS. A narrative review of persistent post-stroke headache - a new entry in the International Classification of Headache Disorders, 3rd edition. Headache 2018; 58 (09) 1442-1453
  • 106 Kahriman A, Zhu S. Migraine and tension-type headache. Semin Neurol 2018; 38 (06) 608-618
  • 107 Kwak S, Chang MC. Management of refractory chronic migraine using ultrasound-guided pulsed radiofrequency of greater occipital nerve: two case reports. Medicine (Baltimore) 2018; 97 (45) e13127
  • 108 Harris P, Loveman E, Clegg A, Easton S, Berry N. Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults. Br J Pain 2015; 9 (04) 213-224
  • 109 Ciancarelli I, Tozzi-Ciancarelli MG, Spacca G, Di Massimo C, Carolei A. Relationship between biofeedback and oxidative stress in patients with chronic migraine. Cephalalgia 2007; 27 (10) 1136-1141
  • 110 Amin FM, Aristeidou S, Baraldi C. et al; European Headache Federation School of Advanced Studies (EHF-SAS). The association between migraine and physical exercise. J Headache Pain 2018; 19 (01) 83