The management of post-stroke pain

Nina Devi Indrawati (1), Laily Irfana (2), Yelvi Levani (3)
(1) Neurology Department Faculty of Medicine Airlangga University, Indonesia,
(2) , Indonesia,
(3) , Indonesia


Stroke is a metabolic illness that causes significant impairment in the working-age population. Disability develops due to the consequences of neurological deficiencies and the failure of the medical rehabilitation process. Post-stroke pain is one of the causes of this failure. In a post-stroke patient, pain is an unpleasant physical and emotional experience. In contrast, range of motion barriers might cause the medical rehabilitation procedure to fail. This paper aims to review the various methods of post-stroke pain management that can be used as an alternative therapy that helps post-stroke patients' rehabilitation. The PubMed database was used to search for different kinds of literature. The study includes clinical studies, pilot studies, and randomized control trials published between January 2015 and June 2023. The authors omit several publications to ensure that the final selection of papers includes only the most relevant and reputable sources of information on post-stroke pain, post-stroke pain management, and pain as a measure of outcome. There are 28 publications to be reviewed. The most prevalent cause of post-stroke pain was hemiplegic shoulder pain in numerous studies that have an impact on the post-stroke recovery process. In conclusion, the options for post-stroke therapy range from conservative rehabilitation to interventional therapy. Several innovative experimental rehabilitation treatment approaches have been studied. However, the findings do not outperform conventional rehabilitation treatment.

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Andersen, L. T. (1985). Shoulder Pain in Hemiplegia . The American Journal of Occupational Therapy, 39(1), 11–19.

Aprile, I., Germanotta, M., Cruciani, A., Pecchioli, C., Loreti, S., Papadopoulou, D., Montesano, A., Galeri, S., Diverio, M., Falsini, C., Speranza, G., Langone, E., Carrozza, M. C., & Cecchi, F. (2021). Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial. International Journal of Stroke, 16(4), 396–405.

Aras, B., Alanbay, E., Kesikburun, S., Kizilirmak, S., Yasar, E., & Tan, A. K. (n.d.). Effectiveness of Suprascapular Nerve Pulsed Radiofrequency Treatment for Hemiplegic Shoulder Pain: A Randomized-Controlled Trial.

Boivie, J., Leijon, G., & Johansson, I. (1989). Central post-stroke pain-a study of the mechanisms through analyses of the sensory abnormalities. In Pain (Vol. 37).

Borboni, A., Villafañe, J. H., Mullè, C., Valdes, K., Faglia, R., Taveggia, G., & Negrini, S. (2017). Robot-Assisted Rehabilitation of Hand Paralysis After Stroke Reduces Wrist Edema and Pain: A Prospective Clinical Trial. Journal of Manipulative and Physiological Therapeutics, 40(1), 21–30.

Broussy, S., Saillour-Glenisson, F., García-Lorenzo, B., Rouanet, F., Lesaine, E., Maugeais, M., Aly, F., Glize, B., Salamon, R., & Sibon, I. (2019). Sequelae and quality of life in patients living at home 1 year after a stroke managed in stroke units. Frontiers in Neurology, 10(AUG).

Chuang, L. L., Chen, Y. L., Chen, C. C., Li, Y. C., Wong, A. M. K., Hsu, A. L., & Chang, Y. J. (2017). Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: A randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 14(1).

Creamer, M., Cloud, G., Kossmehl, P., Yochelson, M., Francisco, G. E., Ward, A. B., Wissel, J., Zampolini, M., Abouihia, A., Calabrese, A., & Saltuari, L. (2018). Effect of intrathecal baclofen on pain and quality of life in poststroke spasticity: A Randomized Trial (SISTERS). Stroke, 49(9), 2129–2137.

Feigin, V. L., Brainin, M., Norrving, B., Martins, S., Sacco, R. L., Hacke, W., Fisher, M., Pandian, J., & Lindsay, P. (2022). World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke, 17(1), 18–29.

Galhardoni, R., Da Silva, V. A., García-Larrea, L., Dale, C., Baptista, A. F., Barbosa, L. M., Bahia Menezes, L. M., De Siqueira, S. R. D. T., Valério, F., Rosi, J., De Lima Rodrigues, A. L., Mendes Fernandes, D. T. R., Lorencini Selingardi, P. M., Marcolin, M. A., De Souza Duran, F. L., Ono, C. R., Lucato, L. T., Fernandes, A. M. B. L., Da Silva, F. E. F., … De Andrade, D. C. (2019). Insular and anterior cingulate cortex deep stimulation for central neuropathic pain disassembling the percept of pain. Neurology, 92(18), E2165–E2175.

Garland, M. (1985). Practical Management of Stroke. Postgraduate Medical Journal, 61(721), 1026–1026.

Griffin, J. W. (1986). Hemiplegic Shoulder Pain. Physical Therapy, 66(12), 1884–1893.

Hernandez-Ort, A. R., Ponce-Luceño, R., Saez-S anchez, C., Garcıa-Sanchez, O., Fernandez-De-las-Pe ñas, C., & de-La-Llave-Rincon, A. I. (2020). Changes in Muscle Tone, Function, and Pain in the Chronic Hemiparetic Shoulder after Dry Needling within or Outside Trigger Points in Stroke Patients: A Crossover Randomized Clinical Trial. Pain Medicine (United States), 21(11), 2939–2947.

Hochsprung, A., Domínguez-Matito, A., López-Hervás, A., Herrera-Monge, P., Moron-Martin, S., Ariza-Martínez, C., Granja-Dominguez, A., & Heredia-Rizo, A. M. (2017). Short- and medium-term effect of kinesio taping or electrical stimulation in hemiplegic shoulder pain prevention: A randomized controlled pilot trial. NeuroRehabilitation, 41(4), 801–810.

Hosomi, K., Kishima, H., Oshino, S., Hirata, M., Tani, N., Maruo, T., Yorifuji, S., Yoshimine, T., & Saitoh, Y. (2013). Cortical excitability changes after high-frequency repetitive transcranial magnetic stimulation for central poststroke pain. Pain, 154(8), 1352–1357.

Huang, Y. C., Chang, K. H., Liou, T. H., Cheng, C. W., Lin, L. F., & Huang, S. W. (2017). Effects of kinesio taping for stroke patients with hemiplegic shoulder pain: A double-blind, randomized, placebo-controlled study. Journal of Rehabilitation Medicine, 49(3), 208–215.

Jan, F., Naeem, A., Malik, A. N., Amjad, I., & Malik, T. (2017). Comparison of low level laser therapy and interferential current on post stroke shoulder pain. JPMA. The Journal of the Pakistan Medical Association, 67(5), 788–789.

Jeon, S., Kim, Y., Jung, K., & Chung, Y. (2017). The effects of electromyography-triggered electrical stimulation on shoulder subluxation, muscle activation, pain, and function in persons with stroke: A pilot study. NeuroRehabilitation, 40(1), 69–75.

Karaahmet, O. Z., Gurcay, E., Unal, Z. K., Cankurtaran, D., & Cakci, A. (2019). Effects of functional electrical stimulation-cycling on shoulder pain and subluxation in patients with acute-subacute stroke: A pilot study. International Journal of Rehabilitation Research, 42(1), 36–40.

Kasapoğlu-Aksoy, M., Aykurt-Karlıbel, İ., & Altan, L. (2020). Comparison of the efficacy of intramuscular botulinum toxin type-A injection into the pectoralis major and the teres major muscles and suprascapular nerve block for hemiplegic shoulder pain: a prospective, double-blind, randomized, controlled trial. Neurological Sciences, 41(8), 2225–2230.

Kim, M. S., Kim, S. H., Noh, S. E., Bang, H. J., & Lee, K. M. (2019). Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 100(6), 1015–1022.

Klit, H., Finnerup, N. B., & Jensen, T. S. (2009). Central post-stroke pain: clinical characteristics, pathophysiology, and management. In The Lancet Neurology (Vol. 8, Issue 9, pp. 857–868).

Korkmaz, N., Gurcay, E., Demir, Y., Tezen, Ö., Korkmaz, İ., Atar, M. Ö., & Yaşar, E. (2022). The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain: a prospective randomized controlled study. Lasers in Medical Science, 37(1), 645–653.

Lannin, N. A., Ada, L., English, C., Ratcliffe, J., Faux, S., Palit, M., Gonzalez, S., Olver, J., Schneider, E., Crotty, M., & Cameron, I. D. (2022). Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial. BMC Neurology, 22(1).

Lempka, S. F., Malone, D. A., Hu, B., Baker, K. B., Wyant, A., Ozinga, J. G., Plow, E. B., Pandya, M., Kubu, C. S., Ford, P. J., & Machado, A. G. (2017). Randomized clinical trial of deep brain stimulation for poststroke pain. Annals of Neurology, 81(5), 653–663.

Lindgren, I., Jönsson, A. C., Norrving, B., & Lindgren, A. (2007). Shoulder pain after stroke: A prospective population-based study. Stroke, 38(2), 343–348.

Marinus, J., Moseley, G. L., Birklein, F., Baron, R., Maihöfner, C., Kingery, W. S., & van Hilten, J. J. (2011). Clinical features and pathophysiology of complex regional pain syndrome. In The Lancet Neurology (Vol. 10, Issue 7, pp. 637–648).

Mendigutía-Gómez, A., Quintana-García, M. T., Martín-Sevilla, M., de Lorenzo-Barrientos, D., Rodríguez-Jiménez, J., Fernández-de-las-Peñas, C., & Arias-Buría, J. L. (2020). Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke. Acupuncture in Medicine, 38(3), 150–157.

Moriarty, O., McGuire, B. E., & Finn, D. P. (2011). The effect of pain on cognitive function: A review of clinical and preclinical research. Progress in Neurobiology, 93(3), 385–404.

Pain, L. A. M., Baker, R., Sohail, Q. Z., Hebert, D., Zabjek, K., Richardson, D., & Agur, A. M. R. (2020). The three-dimensional shoulder pain alignment (3D-SPA) mobilization improves pain-free shoulder range, functional reach and sleep following stroke: a pilot randomized control trial. Disability and Rehabilitation, 42(21), 3072–3083.

Pan, R., Zhou, M., Cai, H., Guo, Y., Zhan, L., Li, M., Yang, Z., Zhu, L., Zhan, J., & Chen, H. (2018). A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clinical Rehabilitation, 32(1), 37–47.

Paolucci, S., Iosa, M., Toni, D., Barbanti, P., Bovi, P., Cavallini, A., Candeloro, E., Mancini, A., Mancuso, M., Monaco, S., Pieroni, A., Recchia, S., Sessa, M., Strambo, D., Tinazzi, M., Cruccu, G., & Truini, A. (2016). Prevalence and time course of post-stroke pain: A multicenter prospective hospital-based study. Pain Medicine (United States), 17(5), 924–930.

Payton, H., & Soundy, A. (2020). The experience of post-stroke pain and the impact on quality of life: An integrative review. In Behavioral Sciences (Vol. 10, Issue 8). MDPI AG.

Pérez-De la Cruz, S. (2020). Influence of an aquatic therapy program on perceived pain, stress, and quality of life in chronic stroke patients: A randomized trial. International Journal of Environmental Research and Public Health, 17(13), 1–12.

Rahmatian, A., Karbasfrushan, A., & Modara, F. (2023). Relationship Between Pain and Disability Among Stroke Patients. Anesthesiology and Pain Medicine, 13(3).

Ralph, S. J., Weissenberger, A., Bonev, V., King, L. D., Bonham, M. D., Ferguson, S., Smith, A. D., Goodman-Jones, A. A., & Espinet, A. J. (2020). Phase I/II parallel double-blind randomized controlled clinical trial of perispinal etanercept for chronic stroke: improved mobility and pain alleviation. Expert Opinion on Investigational Drugs, 29(3), 311–326.

Roy, C. W., Sands, M. R., & Hill, L. D. (n.d.). The effect of shoulder pain on outcome of acute hemiplegia.

Saha, S., Sur, M., Ray Chaudhuri, G., & Agarwal, S. (2021). Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial. Physiotherapy Research International, 26(3).

Serrezuela, R. R., Quezada, M. T., Zayas, M. H., Pedrón, A. M., Hermosilla, D. M., & Zamora, R. S. (2020). Robotic therapy for the hemiplegic shoulder pain: A pilot study. Journal of NeuroEngineering and Rehabilitation, 17(1).

Sezgin Ozcan, D., Tatli, H. U., Polat, C. S., Oken, O., & Koseoglu, B. F. (2019). The Effectiveness of Fluidotherapy in Poststroke Complex Regional Pain Syndrome: A Randomized Controlled Study. Journal of Stroke and Cerebrovascular Diseases, 28(6), 1578–1585.

Shin, S., Yang, S. P., Yu, A., Yoo, J., Lim, S. M., & Lee, E. (2019). Effectiveness and safety of electroacupuncture for poststroke patients with shoulder pain: Study protocol for a double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial. BMC Complementary and Alternative Medicine, 19(1).

Tan, B., & Jia, L. (2021). Ultrasound-guided BoNT-A (botulinum toxin A) injection into the subscapularis for hemiplegic shoulder pain: A randomized, double-blind, placebo-controlled trial. Stroke, 52(12), 3759–3767.

Terlemez, R., Çiftçi, S., Topaloglu, M., Dogu, B., Yilmaz, F., & Kuran, B. (2020). Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections—a randomized controlled study. Neurological Sciences, 41(11), 3243–3247.

Treister, A. K., Hatch, M. N., Cramer, S. C., & Chang, E. Y. (2017). Demystifying Poststroke Pain: From Etiology to Treatment. In PM and R (Vol. 9, Issue 1, pp. 63–75). Elsevier Inc.

Uzdu, A., Kirazlı, Y., Karapolat, H., Unlu, B., Tanıgör, G., & Çalış, F. A. (2021). Efficacy of platelet-rich plasma in the treatment of hemiplegic shoulder pain. Neurological Sciences, 42(5), 1977–1986.

Wasner, G., Lee, B. B., Engel, S., & McLachlan, E. (2008). Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain, 131(9), 2387–2400.

Westerlind, E., Singh, R., Persson, H. C., & Sunnerhagen, K. S. (2020). Experienced pain after stroke: A cross-sectional 5-year follow-up study. BMC Neurology, 20(1).

Zhou, M., Li, F., Lu, W., Wu, J., & Pei, S. (2018). Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 99(9), 1730–1739.


Nina Devi Indrawati (Primary Contact)
Laily Irfana
Yelvi Levani
Author Biography

Nina Devi Indrawati, Neurology Department Faculty of Medicine Airlangga University

Neurology Department
Indrawati, N. D., Irfana, L., & Levani, Y. (2024). The management of post-stroke pain. Qanun Medika - Medical Journal Faculty of Medicine Muhammadiyah Surabaya, 8(01).

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Stroke Lakunar

Laily Irfana
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