Demystifying Poststroke Pain: From Etiology to Treatment.
Andrew K Treister, Maya N Hatch, Steven C Cramer and 1 others
PMID 27317916WHAT IT FOUND
Post-stroke pain has several causes: central pain, CRPS, spasticity, shoulder subluxation.
PT options include exercise, strapping, and FES, but evidence is mixed and drug trials are limited.
Key findings
01In central post-stroke pain, pregabalin did not significantly reduce mean pain score in a placebo-controlled trial of 219 patients, but improved sleep, anxiety, and quality-of-life measures; 70% reported adverse effects.
02In post-stroke complex regional pain syndrome, a controlled study of 52 patients reported 89.9% of those doing four-week upper-extremity aerobic exercise had significant pain relief and fewer CRPS symptoms.
03For hemiplegic shoulder subluxation, prophylactic strapping in 33 patients over 28 days was associated with significantly less pain than placebo and control groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so the search may miss relevant studies. The authors did not report quality appraisal of the included studies. Many treatment findings come from small, open-label, or non-controlled studies. The review summarizes several studies at once, so it cannot show which treatment caused which outcome. Some interventions were delivered alongside usual stroke rehabilitation, and the paper does not separate their effects.
The easy way to misread this
Do not read this review as proof that any treatment works for post-stroke pain. Many cited studies were small, open-label, or non-controlled, and pregabalin did not significantly reduce mean pain score.