Association between Physiological and Subjective Aspects of Pain and Disability in Post-Stroke Patients with Shoulder Pain: A Cross-Sectional Study

• Main Authors: Lydia Martín-Martín, Miguel David Membrilla-Mesa, Mario Lozano-Lozano, Noelia Galiano-Castillo, Carolina Fernández-Lao, Manuel Arroyo-Morales
• Format: Article
• Language: English
• Published: MDPI AG 2019-07-01
• Series: Journal of Clinical Medicine
• Subjects: stroke; pain; disability; central sensitization; pressure pain thresholds
• Online Access: https://www.mdpi.com/2077-0383/8/8/1093

<i>Background</i>: Patients often experience pain as a result of a stroke. However, the mechanism of this pain remains uncertain. Our aim was to investigate the relationship between pressure pain thresholds (PPTs) and disability pain in patients with hemiplegic shoulder pain (HSP). <i>Methods</i>: Twenty-six post-stroke patients (age 53.35 &#177; 13.09 years) and healthy controls (54.35 &#177; 12.37 years) participated. We investigated spontaneous shoulder pain, disability pain perception through the shoulder pain and disability index (SPADI), and the PPTs over joint C5&#8722;C6, upper trapezius, deltoid, epicondyle, second metacarpal, and tibialis anterior, bilaterally. <i>Results</i>: The analysis of variance (ANOVA) showed significant differences in pain between groups (<i>p</i> &lt; 0.001) and differences in the SPADI (<i>p</i> &lt; 0.001) between groups but not between sides for PPTs over deltoid (group: <i>p</i> = 0.007; side: <i>p</i> = 0.750), epicondyle (group: <i>p</i> = 0.001; side: <i>p</i> = 0.848), and tibialis anterior (group: <i>p</i> &lt; 0.001; side: <i>p</i> = 0.932). Pain in the affected arm was negatively associated with PPTs over the affected epicondyle (<i>p</i> = 0.003) and affected tibialis anterior (<i>p</i> = 0.009). Pain (SPADI) appeared negatively correlated with PPTs over the affected epicondyle (<i>p</i> = 0.047), and disability (SPADI) was negatively associated with PPTs over the affected tibialis anterior (<i>p</i> = 0.041). <i>Conclusions</i>: Post-stroke patients showed a relationship between widespread pressure pain hypersensitivity with lower PPT levels and pain disability perception, suggesting a central sensitization mediated by bilateral and symmetric pain patterns.