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      Central Poststroke Pain: Its Profile among Stroke Survivors in Kano, Nigeria

      research-article
      , , ,
      Behavioural Neurology
      Hindawi

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          Abstract

          Background

          Central poststroke pain (CPSP) caused by sensory dysfunction of central origin is a disabling condition that significantly affects the quality of life of stroke patients.

          Aim

          The aim of this study is to determine the clinical profiles and pattern of CPSP among stroke patients in Kano, Nigeria.

          Methods

          The study was a cross-sectional design involving stroke survivors who were ≥18 years old and with no significant cognitive impairment approved by the Research Ethics Committee of Aminu Kano Teaching Hospital. Participants were assessed using diagnostic criteria form, the douleur neuropathique 4 questions (DN4 questionnaire), and Leeds assessment of neuropathic symptoms and signs (LANNS).

          Results

          A total of 120 stroke patients participated in the study, in which 6 (5%) were diagnosed with CPSP occurring within the first 3 months in 50% of the participants. The pain characteristics were mainly moderate (83.3%), burning (62.5%), and continuously experienced (66.7%). The frequently affected parts were extremities or occurring as hemisyndrome.

          Conclusion

          Prevalence of CPSP following stroke is low. The clinical features are variable and can occur at a varied time and different intensities and locations. However, it majorly occurs within the first few months post stroke.

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          Most cited references35

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          Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain.

          A single session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex had been reported to produce short term relief of some types of chronic pain. The present study investigated whether five consecutive days of rTMS would lead to longer lasting pain relief in unilateral chronic intractable neuropathic pain. Forty eight patients with therapy resistant chronic unilateral pain syndromes (24 each with trigeminal neuralgia (TGN) and post-stroke pain syndrome (PSP)) participated. Fourteen from each group received 10 minutes real rTMS over the hand area of motor cortex (20 Hz, 10x10 s trains, intensity 80% of motor threshold) every day for five consecutive days. The remaining patients received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs (LANSS) scale, before, after the first, fourth, and fifth sessions, and two weeks after the last session. No significant differences were found in basal pain ratings between patients receiving real- and sham-rTMS. However, a two factor ANOVA revealed a significant "+/- TMS" x "time" interaction indicating that real and sham rTMS had different effects on the VAS and LANSS scales. Post hoc testing showed that in both groups of patients, real-rTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced adverse effects. These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with TGN or PSP.
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            Shoulder pain after stroke: a prospective population-based study.

            Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund Stroke Register. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30=no-mild and 40 to 100=moderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups. Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively. Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate- severe pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.
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              Central poststroke pain: a review of pathophysiology and treatment.

              Central poststroke pain (CPSP) is a disabling morbidity occurring in 8%-14% of patients with stroke. It is infrequently recognized and difficult to manage. We systematically reviewed the pathophysiology and treatment of CPSP. We conducted a Medline search using the key words "central post-stroke pain," "post-stroke pain," "CPSP and basic studies," "CPSP and clinical features," "CPSP and pharmacological treatment," "CPSP and nonpharmacological treatment" and "CPSP and treatment guideline." The articles related to CPSP were categorized into clinical features, pathophysiology and treatment, and then systematically reviewed. Stroke along the spinothalamocortical pathway may result in CPSP after a variable period, usually after 1-2 mo. CPSP may be spontaneous or evoked, variable in intensity and quality. It tends to improve with time. CPSP is associated with mild motor symptoms with relative sparing of joint position and vibration sensations. The pathophysiology of CPSP is not well understood, but central disinhibition, imbalance of stimuli and central sensitization have been suggested. There are few class I and class II studies regarding its management. Amitriptyline and lamotrigine (class IIB) are recommended as first-line and mexiletine, fluvoxamine and gabapentin as second-line drugs. In pharmacoresistant patients, repetitive transcranial magnetic stimulation and deep brain stimulation have been beneficial. CPSP patients present with diverse sensory symptoms and its pathophysiology is still poorly understood. Amitriptyline and lamotrigine are effective treatments. Further studies are needed to understand the pathophysiology and investigate newer therapeutic modalities.
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                Author and article information

                Contributors
                Journal
                Behav Neurol
                Behav Neurol
                BN
                Behavioural Neurology
                Hindawi
                0953-4180
                1875-8584
                2017
                19 September 2017
                : 2017
                : 9318597
                Affiliations
                Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
                Author notes

                Academic Editor: Mayowa Owolabi

                Author information
                http://orcid.org/0000-0001-9214-3313
                http://orcid.org/0000-0002-7944-1866
                Article
                10.1155/2017/9318597
                5625802
                29056825
                a065ad7f-4c93-49f1-8a28-534fb70ff31c
                Copyright © 2017 Abdulbaki Halliru Bashir et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2017
                : 24 June 2017
                : 26 July 2017
                Categories
                Research Article

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