Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China

摘要

Research Highlights (1) The incidence of shoulder pain post stroke was high. Thus, it is clinically significant to study the onset characteristics and pain management. (2) We analyzed yearly onset condition, age distribution, classification diagnosis, onset period, major symptoms and signs, imaging examinations, misdiagnosis, rehabilitation treatment, and factors influencing curative effects. (3) Involvement of the posterior limb of internal capsule and early onset of shoulder pain can reduce the efficacy of pain management, while pain-related education before treatment and early pain regression increased the efficacy of pain management. In addition, diagnosis type of shoulder pain can influence the efficacy of pain management. We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In particular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxation and complex regional pain syndrome. Multiple linear regression results showed a negative relationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.