Multimodal Treatment for Hemiplegic Shoulder Pain

项目摘要 中风后的肩痛是一个主要的康复问题，影响大约60%的中度至中度中风患者。 严重受损的中风幸存者虽然已经提出了许多治疗HSP的方法，但大多数都不会导致 长期缓解疼痛。我们的长期目标是开发一种治疗干预措施，以减少与HSP相关的疼痛。 在一项随机对照试验的系统综述中，肌内周围神经刺激（PNS）， 由我们的研究小组开发的，是唯一的治疗，以提供长期缓解疼痛的HSP。 我们最近的试点RCT比较了PNS和物理治疗（PT），67%和25%的参与者经历了 成功的疼痛缓解（即，与PNS和PT相比分别降低≥ 2-pt或30%。虽然PNS生产 尽管治疗效果优于PT，但研究中仍有很大比例的无应答者（50%）。此外，委员会认为， 在反应者中，PNS组63%的疼痛缓解不完全，PT组100%。然而，两者 治疗确实在相当数量的参与者中产生了疼痛缓解。因此，一个互补的，多模式的 PNS + PT治疗可增加疼痛显著缓解的患者百分比， 比单独使用PNS或PT更能减轻疼痛。本研究的主要目的是确定 如果HSP联合PNS + PT的多模式治疗比单独使用PNS或PT更有效缓解疼痛。的 次要目的是研究PNS和PT减轻疼痛的机制。为了完成这些 研究者设计了一项多中心、安慰剂对照、双盲RCT，以确定 HSP与PNS + PT的多模式治疗比单独的PNS或PT更有效地缓解疼痛。措施 疼痛，疼痛干扰ADL，QoL，肩关节生物力学（肩关节外展扭矩，肩关节 运动学和Fugl-Meyer评分）和中枢致敏性（疼痛阈值，继发性 痛觉过敏和时间总和）。参与者将被随访共计24周 治疗结束后。

PROJECT SUMMARY Shoulder pain following stroke is a major rehabilitation problem affecting approximately 60% of moderate to severely impaired stroke survivors. While many treatments for HSP have been proposed, most do not result in long-term relief of pain. Our long-term goal is to develop a therapeutic intervention to reduce pain related to HSP. In a systematic review of randomized controlled trials, intramuscular peripheral nerve stimulation (PNS), developed by our research group, was the only treatment to provide long-term relief of pain for those with HSP. Our recent pilot RCT compared PNS to physical therapy (PT) and 67% vs. 25% of participants experienced successful pain relief (i.e., ≥ 2-pt or 30% reduction) from PNS and PT, respectively. Although PNS produced better outcomes than PT, there was still a large percentage of non-responders (50%) in the study. Furthermore, amongst responders, pain relief was incomplete in 63% of the PNS group and 100% in the PT group. Yet, both treatments did produce pain relief in a significant number of participants. Thus, a complementary, multimodal treatment of PNS + PT may increase the percentage of patients who experience significant pain relief and will produce a greater reduction in pain than with PNS or PT alone. The primary objective of this study is to determine if multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. The secondary objective is to investigate mechanisms of pain reduction by PNS and PT. In order to accomplish these objectives, the investigators designed a multi-site, placebo controlled, double-blinded RCT to determine if multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. Measures of pain, pain interference with ADLs, QoL, shoulder biomechanics (shoulder abduction torque, shoulder kinematics, and Fugl-Meyer score), and measures of central sensitization (pain thresholds, secondary hyperalgesia, and temporal summation) will be measured. Participants will be followed for a total of 24 weeks after treatment has concluded.