Association between physiological and subjective aspects of pain and disability in post-stroke patients with shoulder pain: A cross-sectional study

Abstract

Background: 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). Methods: Twenty-six post-stroke patients (age 53.35 ± 13.09 years) and healthy controls (54.35 ± 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–C6, upper trapezius, deltoid, epicondyle, second metacarpal, and tibialis anterior, bilaterally. Results: The analysis of variance (ANOVA) showed significant differences in pain between groups (p < 0.001) and differences in the SPADI (p < 0.001) between groups but not between sides for PPTs over deltoid (group: p = 0.007; side: p = 0.750), epicondyle (group: p = 0.001; side: p = 0.848), and tibialis anterior (group: p < 0.001; side: p = 0.932). Pain in the affected arm was negatively associated with PPTs over the affected epicondyle (p = 0.003) and affected tibialis anterior (p = 0.009). Pain (SPADI) appeared negatively correlated with PPTs over the affected epicondyle (p = 0.047), and disability (SPADI) was negatively associated with PPTs over the affected tibialis anterior (p = 0.041). Conclusions: 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.