File
Ofek H1, Alperin M2, Knoll T2, Livne D2, Laufer Y1
1University of Haifa, Haifa, Israel, 2Clalit Health Services, Haifa and Western Galilee, Israel
Background: Post stroke pain is present in 11%-55% of individuals post-stroke. Somatosensory impairment due to central nervous system injury or malfunction is highly correlated with existence of central neuropathic pain syndrome. Pain, expressed to body parts with altered somatosensation, is shown to be a barrier for post-stroke rehabilitation and for the ability to return to optimal participation. To date the available treatment is mainly pharmacological. Explicit sensory discrimination training was found effective in peripheral neuropathic pain syndromes and was suggested but not studied for the treatment of Central Post Stroke Pain (CPSP).
Purpose: To study the effect of explicit sensory rehabilitation (i.e. sensory discrimination training) for pain alleviation in individuals reporting CPSP, and compare it with a repeated exposure to stimuli intervention.
Methods: Twenty three individuals, 6 months or more post-stroke with CPSP, were recruited within a larger sample of subjects with post-stroke sensory impairments participating in a randomized controlled trial of sensory rehabilitation. Participants were assessed twice pre-intervention (a week apart) and twice post-intervention (immediately after and at three months followup), by a physical therapist blind to treatment allocation. Intervention included 10 forty five minute sessions of explicit sensory discrimination training (n=11) or for repeated exposure to stimuli (n=12) conducted in an outpatient physical therapy clinic. Pain was assessed by visual analogue scale (VAS) (0-100) and by the McGill questionnaire. Activities and participation were assessed by Timed Up and Go test (TUG), by Activities-specific Balance Confidence questionnaire (ABC), mini Balance Evaluation Systems Test (miniBEST), two minute walk and Stroke Impact Scale (SIS)-Activities of Daily Living / SIS-participation sections. In an intention to treat analysis, ANOVA and post hoc tests were used to determine treatment effects over time. Significance was set at p≤0.05.
Results: Twenty three subjects reported relevant contralesional pain and were included in the CPSP subgroup, out of the 64 subjects with sensory impairment post-stroke (34%). a stable baseline was assured between the two pre-treatment sessions. Significant post treatment groupXtime interaction was demonstrated for pain level as measured by VAS. SMM Post hoc test indicated a significant difference for the explicit sensory discrimination training group between times (p=0.01), as the mean score decreased from (56.2±21.2) pre-treatment to (24.0±33.3) post-treatment for the sensory discrimination training group, with no significant difference for the repeated exposure group (49.8±22.6) pre-treatment to (50.4±35.7) post-treatment. Post treatment levels were maintained at followup. Significant post treatment improvements were demonstrated for all activities and participation variables (p 0.0001) for both groups with no groupXtime effect, with gains stable at 3 months followup.
Conclusion(s): Explicit sensory discrimination training was found to be effective for the alleviation of central neuropathic pain post-stroke. Repeated exposure to stimuli was not found effective. However, both treatment approaches were effective for activities and participation improvement on individuals with sensory loss post-stroke and CPSP.
Implications: The results of this study suggest a physical therapy intervention for CPSP, which to date has been treated only pharmacologically.
Keywords: Stroke, Central Post Stroke Pain (CPSP), Randomized Controlled Trial (RCT)
Funding acknowledgements: Non
Purpose: To study the effect of explicit sensory rehabilitation (i.e. sensory discrimination training) for pain alleviation in individuals reporting CPSP, and compare it with a repeated exposure to stimuli intervention.
Methods: Twenty three individuals, 6 months or more post-stroke with CPSP, were recruited within a larger sample of subjects with post-stroke sensory impairments participating in a randomized controlled trial of sensory rehabilitation. Participants were assessed twice pre-intervention (a week apart) and twice post-intervention (immediately after and at three months followup), by a physical therapist blind to treatment allocation. Intervention included 10 forty five minute sessions of explicit sensory discrimination training (n=11) or for repeated exposure to stimuli (n=12) conducted in an outpatient physical therapy clinic. Pain was assessed by visual analogue scale (VAS) (0-100) and by the McGill questionnaire. Activities and participation were assessed by Timed Up and Go test (TUG), by Activities-specific Balance Confidence questionnaire (ABC), mini Balance Evaluation Systems Test (miniBEST), two minute walk and Stroke Impact Scale (SIS)-Activities of Daily Living / SIS-participation sections. In an intention to treat analysis, ANOVA and post hoc tests were used to determine treatment effects over time. Significance was set at p≤0.05.
Results: Twenty three subjects reported relevant contralesional pain and were included in the CPSP subgroup, out of the 64 subjects with sensory impairment post-stroke (34%). a stable baseline was assured between the two pre-treatment sessions. Significant post treatment groupXtime interaction was demonstrated for pain level as measured by VAS. SMM Post hoc test indicated a significant difference for the explicit sensory discrimination training group between times (p=0.01), as the mean score decreased from (56.2±21.2) pre-treatment to (24.0±33.3) post-treatment for the sensory discrimination training group, with no significant difference for the repeated exposure group (49.8±22.6) pre-treatment to (50.4±35.7) post-treatment. Post treatment levels were maintained at followup. Significant post treatment improvements were demonstrated for all activities and participation variables (p 0.0001) for both groups with no groupXtime effect, with gains stable at 3 months followup.
Conclusion(s): Explicit sensory discrimination training was found to be effective for the alleviation of central neuropathic pain post-stroke. Repeated exposure to stimuli was not found effective. However, both treatment approaches were effective for activities and participation improvement on individuals with sensory loss post-stroke and CPSP.
Implications: The results of this study suggest a physical therapy intervention for CPSP, which to date has been treated only pharmacologically.
Keywords: Stroke, Central Post Stroke Pain (CPSP), Randomized Controlled Trial (RCT)
Funding acknowledgements: Non
Topic: Neurology: stroke; Pain & pain management
Ethics approval required: Yes
Institution: Clalit health services
Ethics committee: Community Helsinki ethical committee
Ethics number: 0034-13-COM
All authors, affiliations and abstracts have been published as submitted.
