Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews

Bilateral training guided by contralaterally controlled functional electrical stimulation for shoulder pain and subluxation in subacute stroke: A randomized controlled trial

BackgroundShoulder pain, subluxation, and motor dysfunction are common issues in hemiplegic patients, which hinder the recovery of upper limb function and have a negative impact on patients' daily life abilities and quality of life. Current rehabilitation interventions alone can not purposefully address the aforementioned problems, while bilateral training (BT) and contralaterally controlled functional electrical stimulation (CCFES) can be synergistically coordinated to provide a simultaneous treatment for hemiplegic shoulders.ObjectiveThis study attempted to treat hemiplegic patients using bilateral training with contralaterally controlled functional electrical stimulation (BT-CCFES), aiming to observe the changes of shoulder pain, subluxation, and motor function.MethodsThirty-eight individuals who had experienced hemiplegia with shoulder pain and subluxation due to stroke were randomly divided into two groups: a control group and an experimental group consisting of nineteen cases both. Patients in the control group underwent neuromuscular electrical stimulation (NMES) therapy, while those in the experimental group received BT-CCFES. Before and after a four-week treatment period, shoulder subluxation distance (SSD) was measured using a flexible ruler, and the pain level was assessed using the visual analogue scale (VAS). Additionally, shoulder joint active range of motion (AROM) and the upper extremity Fugl-Meyer assessment (UE-FMA) were used to evaluate shoulder motor function.ResultsAfter four weeks of treatment, there were significant improvements in SSD, VAS, UE-FMA, and AROM in the experimental group (p < 0.001), as well as in the control group (p < 0.05). The changes between the experimental group and control group showed significant differences in SSD (-9.74 ± 6.63 vs -3.58 ± 5.51, p = 0.016), flexion (37.37 ± 14.08 vs 21.05 ± 12.65, p = 0.001), and UE-FMA (15.21 ± 4.30 vs 8.84 ± 4.26, p < 0.001), while the difference in VAS (-1.31 ± 1.34 vs -1.10 ± 1.24, p = 0.619) and abduction (15.00 ± 8.82 vs 10.79 ± 7.86, p = 0.111) was not significant.ConclusionBT-CCFES can be used to prevent and treat hemiplegic shoulder subluxation after stroke, improve shoulder and upper limb function, and is superior to NMES except in pain relief.

Bee Venom Acupuncture in Traditional Korean Medicine: A Review of Clinical Practice Guidelines

Bee venom acupuncture (BVA) is used in traditional Korean medicine (TKM) for various diseases, but its evaluation within clinical practice guidelines (CPGs) has not been comprehensively reviewed. This study aimed to review TKM-CPGs to characterize the range of conditions for which BVA is recommended, summarize the level of evidence and recommendation grades, and assess the factors influencing the grades. Eighteen TKM-CPGs, including 30 BVA-related recommendations, were identified. Data on targeted diseases/symptoms, treatment protocols, evidence levels, and recommendation grades were extracted. The CPGs recommended BVA for musculoskeletal and neurological disorders in standalone or combined therapy. Most of the evidence for BVA recommendations was evaluated with low to moderate levels based on randomized controlled trials. The grades of recommendations were mostly B or C, indicating that BVA is advisable or potentially beneficial. Although the CPGs offer some guidance on treatment protocols for BVA, there remains a lack of detailed specifications, and we need to conduct additional research to provide evidence. Also, the heterogeneity of recommendations across different CPGs presents a challenge in establishing consistent clinical guidelines. Future research should focus on generating high-quality evidence and standardizing treatment regimens to support more robust recommendations for BVA in TKM clinical practice.

The effect of ultrasound-guided botulinum toxin injections on pain, functionality, spasticity, and range of motion in patients with post-stroke upper extremity spasticity

OBJECTIVE

Spasticity developing in the upper extremity in stroke patients causes disability by limiting movement and causing pain. This study investigates the effects of botulinum toxin injections on pain, functionality, spasticity, and range of motion in hemiplegic patients with post-stroke spasticity.

MATERIALS AND METHODS

The study involved a double-blind, prospective, randomized controlled trial with thirty-one stroke patients aged 35-80 who developed upper extremity spasticity. The study group (n=16) received botulinum toxin-A (BT-A) injections in addition to conventional rehabilitation and stretching exercises, while the control group (n=15) received placebo injections. Evaluations were conducted before treatment, in the second week, and three months after treatment. The study evaluated pain relief through the Visual Analog Scale (VAS), assessed spasticity with the Modified Ashworth Scale (MAS), and measured functionality using the Fugl Meyer Assessment Scale (FMAS) and the Box Block Test (BBT).

RESULTS

The mean age of patients was 56.03±11.81. The median time after stroke was 24 months. The BT-A group demonstrated significantly lower VAS and MAS scores compared to controls at both 2 weeks and 3 months after treatment. Additionally, the BT-A group showed significantly higher changes in arm, wrist, and total FMAS scores compared to the control group. However, no significant difference was found in terms of hand, coordination, and speed FMAS score changes.

CONCLUSIONS

The results of our study demonstrated that BT-A injection with ultrasonography guidance is an effective method for alleviating pain caused by passive shoulder movement, significantly reducing spasticity, and markedly improving motor functions.

Retrospective Cohort Study on the Incidence and Management of Hemiplegic Shoulder Pain in Stroke Inpatients

BACKGROUND

Painful hemiplegic shoulder (PHS) is a prevalent and challenging complication following a stroke and can significantly impair a patient's engagement in rehabilitation, leading to poorer functional outcomes and extended hospital stays. This retrospective cohort study aims to investigate the incidence, etiology, and management of PHS in stroke inpatients, focusing on the effectiveness of various therapeutic interventions.

METHODS

We conducted a retrospective analysis of subacute stroke inpatients who developed PHS during rehabilitation at a single center. Medical records were reviewed to assess the incidence of PHS, underlying causes, and treatment modalities. Primary outcome measures included the prevalence of PHS, the distribution of identified etiologies, and therapeutic outcomes associated with different management strategies.

RESULTS

Our findings revealed a significant prevalence of PHS among stroke inpatients, consistent with existing literature. The multifactorial etiology included spasticity, adhesive capsulitis, glenohumeral subluxation, central post-stroke pain, and complex regional pain syndrome, with advanced age, low functional scores, motor and sensory impairments, and comorbidities such as diabetes mellitus identified as key risk factors. Management strategies ranged from conservative approaches, such as physical modalities and slings, to advanced interventions, including intra-articular corticosteroid injections, botulinum toxin type A applications, nerve blocks, and radiofrequency neuromodulation. Corticosteroid injections and electrical stimulation were particularly effective in alleviating pain and improving functional outcomes. Notably, pulsed radiofrequency modulation targeting the suprascapular and axillary nerves showed superior efficacy in enhancing the passive range of motion compared to conventional nerve blocks, although the effectiveness of botulinum toxin type A was inconsistent.

CONCLUSIONS

This study emphasizes the multifaceted nature of PHS in stroke inpatients, underlining the importance of individualized and comprehensive treatment strategies. While several therapeutic interventions, particularly corticosteroid injections and pulsed radiofrequency, demonstrated effectiveness, the variability in treatment outcomes highlights the need for further investigation. Future research should focus on larger patient cohorts with extended follow-up periods to better elucidate the progression of PHS and refine management approaches. Despite limitations, including the retrospective study design and a short follow-up period, these findings provide valuable insights into the prevalence, progression, and treatment of PHS in stroke rehabilitation.

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial

BACKGROUND

Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.

METHODS

This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.

DISCUSSION

Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.

TRIAL REGISTRATION

Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 .

High frequency neuronavigated repetitive transcranial magnetic stimulation in post-stroke shoulder pain: A double-blinded, randomized controlled study

OBJECTIVE

This study aimed to determine the effect of 5Hz neuronavigated repetitive transcranial magnetic stimulation (rTMS) to the affected primary motor cortex (M1) on pain, the effect of pain on activities of daily living, disability, mood, neurophysiological parameters and passive shoulder joint range of motion in patients with post-stroke shoulder pain.

DESIGN

Twenty two patients were randomized into an experimental group (rTMS, n=7) who received daily rTMS 5Hz 1000 pulses, five times/week for three weeks (15 sessions) to the affected M1 and a control group (n=11) who received sham stimulation. Outcome measures were Numeric Rating Scale (NRS), Brief Pain Inventory (BPI), Disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), Hospital Depression Anxiety Scale (HADS), joint range of motion (ROM) measurements, neurophysiological parameters. Selected outcome measures were performed before treatment (T0), after the 5th session (T1) of rTMS treatment, after the 10th session (T2), after the 15th session (T3), and four weeks after the end of the treatment (T4). In the analysis of the outcomes, within-group comparisons were performed by using the Wilcoxon or Friedman test and between-group comparisons were performed by using the Mann-Whitney U test.

RESULTS

There was no statistically significant difference between and within groups in terms of change- and followup scores in the NRS measurements (p>0.05). BPI scale was found to be lower in rTMS group at T0 and T3 (p= 0.010). Quick-DASH scores at T4 were found to be significantly lower in rTMS group (p= 0.032). However, no difference was found within each group over time (p>0.05) and there was no statistical difference between the groups in terms of change scores (T3-T0 and T4-T0) (p>0.05) for BPI and Quick-DASH. In rTMS group, there was a statistically significant difference in shoulder external rotation at T3 compared to the baseline (T0) (p=0.039). However, the magnitude of external rotation change (T3-T0) with the treatment was comparable in the groups. No statistically significant change occurred in both treatment groups in other range of motion measurements.

CONCLUSION

High frequency neuronavigated rTMS to the affected M1 did not show any significant beneficial effect on pain, activities of daily living, disability, anxiety and depression, neurophysiological measurements and passive ROM over sham stimulation.

The trajectory of pain and pain intensity in the upper extremity after stroke over time: a prospective study in a rehabilitation population

PURPOSE

To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain.

MATERIALS AND METHODS

Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0-10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively.

RESULTS

678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74-0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0-7.0 at 3 and 3.0-6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time.

CONCLUSIONS

The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time.IMPLICATIONS FOR REHABILITATIONAbout one-third of patients with stroke reported upper extremity pain at 30 months after starting rehabilitation.In patients with stroke who reported persistent upper extremity pain, there was no significant change in pain intensity over time.There is room for improvement of diagnosis and treatment of upper extremity pain in patients with stroke.

Investigating the traditional medicine shoulder pain (Jian Tong) characteristics in patients with ischaemic stroke in the early rehabilitation phase

Introduction

Ischaemic stroke often leaves serious sequelae affecting patients' daily activities and quality of life, especially shoulder pain. Shoulder pain after stroke often occurs in the first 3 months with an occurrence rate of 25-72% due to the strong natural neurological mechanism during the time, interferes with the recovery of motor function, increases hospital stay, is associated with depression, and limits mobility as well as inhibits treatment results. In Vietnam, Traditional Medicine (TM) has played an essential role in treating and rehabilitating shoulder pain after stroke for quite a long time. Studies on the pathology of shoulder pain (Jian Tong) after stroke in TM in Vietnam are still inadequate. Therefore, this study evaluated the severity and characteristics of post-stroke Jian Tong in patients with ischaemic stroke.

Methods

The study was conducted from January 1, 2023-May 1, 2023. The study consisted of two phases: Phase 1: Searching TM documents and selecting the characteristics that appear in the documents as components for the questionnaire of phase 2. Phase 2: Conduct a cross-sectional study to investigate the characteristics of Jian Tong in 65 patients after ischaemic stroke in the early rehabilitation phase.

Results

In phase 1, the study encoded 17 features of Jian Tong from 10 literary documents. In phase 2, we surveyed over 65 patients, and the result was that shoulder pain aggravated by exertion had the highest rate, whereas shoulder pain alleviated by cold and distended shoulder had the fewest. Pain level measured by Number Rating Scale (NRS) points and gender was significantly related to the characteristics of TM shoulder pain - Jian Tong (p < 0.05).

Conclusion

The study demonstrated the pain level and the characteristics of Jian Tong in patients with ischaemic stroke in the early rehabilitation phase to contribute to the process of personalized diagnosing and treating Jian Tong after stroke for each patient, especially based on the theoretical basis and reasoning methods of Traditional Medicine.

A retrospective examination of pain in acute stroke at hospital discharge

OBJECTIVES

Pain is an overlooked sequela of stroke. Persistent pain after stroke is an underrecognized experience and significantly impacts survivors' function, ability to participate in rehabilitation, and quality of life. The aim of this retrospective, observational study is to examine the incidence of pain at the acute hospitalization period immediately after stroke, to identify the characteristics of those reporting pain at discharge, and to compare pain reporting between stroke and non-stroke hospital controls.

MATERIALS AND METHODS

Using discharge diagnosis, this retrospective review examined self- reports of pain during acute hospitalization for stroke compared to those with COPD (control group) admitted during the same time in the same facilities. Variables of interest included age, gender, body mass index (BMI), length of stay, pain assessment score (numeric rating scale [NRS], behavior pain scale [BPS], and medication administration record pain score total [MAR]), smoking history, prevalence of hypertension and race. 821 subjects were included from a total of three campuses from one large hospital system. 772 subjects were included in the comparative analysis with COPD patients from the same facilities during the same time.

RESULTS

43% of patients diagnosed with stroke reported pain at discharge. For stroke survivors reporting pain at discharge, the average BMI was higher (p=0.009), average arrival NIHSS was higher (p=0.044), and mean hospital length of stay was longer (p<0.001).

CONCLUSIONS

The evidence demonstrated in this study highlights the critical need for the implementation of targeted objective pain assessment and effective pain interventions for stroke survivors beginning at initial hospitalization.

Changes in serum levels of pain mediators in hemiplegic shoulder pain

OBJECTIVE

To provide a new insight into the diagnosis and treatment of hemiplegic shoulder pain (HSP) by investigating changes in serum pain mediators.

DESIGN

Cross-sectional study.

SUBJECTS/PATIENTS

Shoulder pain group (n = 34) and control group (n = 21).

METHODS

Pain-free shoulder mobility, anxiety status, depression status, and shoulder pain were measured by passive range of motion (PROM), self-rating anxiety scale, self-rating depression scale (SDS), and visual analog scale, respectively. The enzyme-linked immunosorbent assay was used to test the serum pain mediators, including interleukin (IL)-1β, IL-2, IL-6, IL-10, nerve growth factor (NGF), tumor necrosis factor-α (TNF-α), substance P (SP), calcitonin gene-related peptide (CGRP), bradykinin (BK), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2), and lysophosphatidic acid (LPA).

RESULTS

Shoulder pain group pain-free PROM significantly lower than control (p < .01), and SDS index score of shoulder pain group was significantly higher than control (p < .05). The rate of spasticity in the flexor elbow muscles is higher in shoulder pain group (p < .01). CGRP, IL-10, and IL-2 were significantly upregulated in shoulder pain group compared with control (p < .01), whereas NGF, TNF-α, IL-6, 5-HT, PGE2, SP, LPA, BK, and IL-1β were significantly decreased (p < .01).

CONCLUSION

Patients with HSP have a higher risk of joint mobility disorders and depression; spasticity may be an important factor in the development of shoulder pain; CGRP is thought to be the major pain mediator in HSP, and HSP may not be inflammatory.

Robotic-Assisted Rehabilitation for Post-Stroke Shoulder Pain: A Systematic Review

Post-stroke shoulder pain (PSSP) is a debilitating consequence of hemiplegia, often hindering rehabilitation efforts and further limiting motor recovery. With the advent of robotic-assisted therapies in neurorehabilitation, there is potential for innovative interventions for PSSP. This study systematically reviewed the current literature to determine the effectiveness of robotic-assisted rehabilitation in addressing PSSP in stroke patients. A comprehensive search of databases was conducted, targeting articles published up to August 2023. Studies were included if they investigated the impact of robotic-assisted rehabilitation on PSSP. The outcome of interest was pain reduction. The risk of bias was assessed using the Cochrane database. Of the 187 initially identified articles, 3 studies met the inclusion criteria, encompassing 174 patients. The reviewed studies indicated a potential benefit of robotic-assisted rehabilitation in reducing PSSP, with some studies also noting improvements in the range of motion and overall motor function. However, the results varied across studies, with some showing more significant benefits than others, because these use different protocols and robotic equipment.

Use of Botulinum Toxin as a Treatment of Hemiplegic Shoulder Pain Syndrome: A Randomized Trial

OBJECTIVE

The primary objective of this paper is to assess whether the use of 200 units of abobotulinum in the pectoralis major and subscapularis muscles modifies the pain complaint assessed using the visual analog scale in subjects with shoulder pain after the onset of spastic hemiplegia due to cerebrovascular disease when compared to the application of a placebo to the same muscles.

DESIGN

A prospective, double-blind, randomized, and placebo-controlled clinical trial study in two different rehabilitation centers.

SETTING

Two distinct outpatient neurological rehabilitation services.

PARTICIPANTS

Patients older than 18 years who were included presented upper limb spasticity resulting from ischemic or hemorrhagic stroke and a diagnosis of Painful Hemiplegic Shoulder Syndrome (PHSS) that was independent of motor dominance.

INTERVENTIONS

Patients were divided into two groups, one of them underwent the application of botulinum toxin (TXB-A) in the pectoralis major and subscapularis muscles, at a total dose of 400 U.

MAIN OUTCOME MEASURE

Patients were assessed for a change in pain using the Visual Analog Scale (VAS) for at least 13 mm.

RESULTS

An improvement in pain and spasticity levels in both groups, more intense in the toxin group, but without statistical significance. The comparison between the groups showed a reduction in pain by VAS (p = 0.52).

CONCLUSIONS

The use of botulinum toxin in the subscapularis and pectoralis major muscles resulted in a reduction in shoulder pain in spastic hemiplegic patients without statistical significance.

A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity

Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient's condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.

Effect of electroacupuncture treatment combined with rehabilitation care on serum sirt3 level and motor function in elderly patients with stroke hemiparesis

OBJECTIVE

Acupuncture treatment helps to improve neurological and motor function in elderly patients with stroke hemiplegia. However, the exact mechanism by which electroacupuncture improves stroke hemiparesis is uncertain. The aim of this study was to determine the effect of electroacupuncture care on sirt3 levels in elderly patients with stroke hemiparesis.

METHODS

One hundred and ten elderly patients with hemiplegia after first stroke were divided into an experimental group and a control group (n = 55 in each group). The control group was given conventional rehabilitation care by a rehabilitation therapist. In the experimental group, on the basis of conventional rehabilitation care, electroacupuncture was performed once a day for 28 days.

RESULTS

Fugl-Meyer assessment (FMA) and barthel index (BI) scores were significantly higher, while neurologic deficit scale (NDS) and physiological state scores were significantly lower in both groups after 14 and 28 days of intervention compared to preintervention. The Generalized estimating equation (GEE) model also showed that the experimental group showed more favorable improvements in all outcomes at postintervention time points compared to the control group. After the intervention, serum sirt3 levels increased significantly in both groups compared to preintervention, and the increase was more pronounced in the experimental group. Consistently, the GEE model showed that serum sirt3 levels were significantly higher in the experimental group compared to the control group at postintervention time points. Correlation analysis revealed that serum sirt3 levels in the experimental group were negatively correlated with FMA and BI pre- and postintervention, while showing a significant positive correlation with NDS and physiological state scores.

CONCLUSION

Electroacupuncture intervention led to significant improvements in motor function, activities of daily living and neurological function in elderly patients with stroke hemiplegia, which may be associate with increased serum sirt3 levels.

Application of Acupuncture for Shoulder Pain Over the Past 22 Years: A Bibliometric Analysis

Purpose

Acupuncture is widely used to relieve shoulder pain. A survey was conducted in order to recognize hotspots and frontiers of acupuncture for shoulder pain from the year 2000-2022.

Methods

The Web of Science Core Collection was used to collect literature related to acupuncture therapy for shoulder pain, which spanned January 2000 to August 2022. The number of publications yearly, countries/institutions, journals, and keywords was analyzed and visualized in shoulder pain with acupuncture therapy by CiteSpace v.5.7.R5.

Results

We totally analyzed 214 articles that met the inclusion criteria. The overall trend of publication volume continues to increase. The most productive authors in the field were César Fernández las Peñas and José L Arias-Buría, and the most influential author was Green S. Kyung Hee University and the People's Republic of China had the highest volume of publications, respectively. The most influential journal is Pain with high citation and impact factor. The hot keywords were "acupuncture", "shoulder pain", "dry needling", "randomized trial", and "injection". The research frontier in acupuncture for treating chronic shoulder pain was mainly "mechanism".

Conclusion

Over the last 22 years, the findings of this bibliometric analysis have provided research trends and frontiers in clinical research on acupuncture therapy for patients with shoulder pain, which identifying hot topics and exploring new directions for the future may be helpful to researchers. Studying mechanisms underlying acupuncture therapy for shoulder pain remains a focus of future research.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain

BACKGROUND

Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP.

OBJECTIVE

This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP.

METHODS

In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire.

RESULTS

The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups.

CONCLUSION

TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Research Hotspots and Frontiers in Post Stroke Pain: A Bibliometric Analysis Study

Background

Pain is a common complication after stroke with a high incidence and mortality rate. Many studies in the field of pain after stroke have been published in various journals. However, bibliometric analysis in the domain of pain after stroke is still lacking. This study aimed to deliver a visual analysis to analyze the global trends in research on the comorbidity of pain after stroke in the last 12 years.

Methods

The publications from the Web of Science (WoS) in the last 12 years (from 2010 to 2021) were collected and retrieved. CiteSpace software was used to analyze the relationship of publication year with countries, institutions, journals, authors, references, and keywords.

Results

A total of 322 publications were included in the analysis. A continuous but unstable growth in the number of articles published on pain after stroke was observed over the last 12 years. The Peoples' R China (65), Chang Gung University (10), and Topic in Stroke Rehabilitation (16) were the country, institution, and journal with the highest number of publications, respectively. Analysis of keywords showed that shoulder pain after stroke and central post-stroke pain were the research development trends and focus in this research field.

Conclusion

This study provides a visual analysis method for the trend and frontiers of pain research after stroke. In the future, large sample, randomized controlled trials are needed to identify the potential treatments and pathophysiology for pain after stroke.

Risk factors for shoulder pain after stroke: A clinical study

Objectives:

To investigate the risk factors for shoulder pain after stroke, and prevent its occurrence effectively.

Methods:

The patients with stroke treated in our hospital between September 2016 and October 2020 were reviewed retrospectively. The medical records of the included patients including age, gender, lesion side, stroke duration, hospital stay, diabetes, hypertension, heart disease, limitation of shoulder joint activity, alcohol abuse, smoking, type of stroke, Ashworth scale, Brunnstrom stage, sensory disorders, and motor arm score of National Institutes of Health Stroke Scale (NIHSS) were collected and analyzed to determine the risk factors for shoulder pain after stroke.

Results:

A total of 1390 patients were included based on the inclusion and exclusion criteria, consisting of 162 patients with shoulder pain after stroke and the prevalence was 11.6%. The included patients were divided into shoulder pain group and non-shoulder pain group. There were significant differences in age, stroke duration, hospital stay, diabetes, limitation of shoulder joint activity, Ashworth scale, Brunnstrom stage, sensory disorders, and motor arm score of NIHSS between the two groups (P < 0.05). Based on the multivariate regression analysis, the independent risk factors for shoulder pain after stroke included diabetes, limited shoulder joint activity, Brunnstrom grade I-III period, Ashworth 3-4 grade, motor arm score of NIHSS 3-4 points, and sensory disturbance.

Conclusion:

Great emphasis should be placed on the stroke patients with diabetes, limited shoulder joint activity, Brunnstrom grade I-III period, Ashworth 3-4 grade, motor arm score of NIHSS 3-4 points, or sensory disturbance, as these patients have higher risks for shoulder pain after stroke.