Atypical Central Neuropathic Pain Following Stroke Presenting With Distal Movement-Evoked Shoulder Pain: A Case Report.

It describes a single case, so it cannot show how common the pattern is or whether any treatment caused the improvement. No objective biomarker, advanced neuroimaging, neurophysiological assessment, or quantitative sensory testing confirmed central neuropathic pain. Pain was assessed by patient report in a person with cognitive impairment and hemispatial neglect, so the report may be affected by those conditions. Several treatments were given one after another, including baclofen, paracetamol, tramadol, topical ketoprofen, acupuncture, botulinum toxin, bursal injection, pregabalin, nerve block, duloxetine, and nortriptyline, so the effect of any single component cannot be separated. Shoulder osteoarthritis and bursitis were present, so peripheral shoulder pain could still contribute. The bone scan was indeterminate for complex regional pain syndrome, and the patient did not meet Budapest criteria. No specific neuropathic pain screening questionnaire, such as the Douleur Neuropathique en 4 Questions, was performed.

This research did not receive a specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Institutional research ethics board approval was not required for this case report.

Do not conclude that this pattern proves central neuropathic pain or that any single medication worked. It is a single case, the diagnosis was not confirmed by objective testing, and multiple treatments were given sequentially and overlapped, so their separate effects cannot be separated.