Shoulder Pain Reduction

Wilson_Shoulder_Pain-01Overview

Shoulder pain following stroke is very common, often debilitating, and difficult to treat. It is a major rehabilitation problem affecting a large number of stroke survivors, and it is associated with poor rehabilitation outcomes, including impaired activities of daily living and poor quality of life. There is no standard treatment for shoulder pain following stroke, although physical therapy is usually a component. Several areas of research exist to better understand both the problem of shoulder pain and its potential treatment. One treatment is the injection of corticosteroids into a bursa just above the shoulder joint to reduce inflammation. Although subacromial corticosteroid injection is already commonly prescribed by physicians to treat post-stroke shoulder pain, the dose of steroid that leads to the best pain relief is not known. Thus FESC investigators are comparing the efficacy of 3 doses of steroids in reducing shoulder pain. Neuromuscular Electrical Stimulation to strengthen the muscles around the shoulder is another approach to treating post-stroke shoulder pain. There is existing evidence that surface electrical stimulation of the shoulder muscles may be an effective treatment. However, many patients have difficulty using surface electrical stimulation due to its discomfort and difficulty placing electrodes. Thus, FESC Investigators are evaluating a technique where electrodes are implanted directly in the muscle for temporary applications. These electrodes are easily removed after completion of treatment.

 


Subacromial Corticosteroid Injection for Hemiplegic Shoulder Pain

Purpose: Evaluate the relative efficacy of 3 different doses of corticosteroid in reducing post-stroke shoulder pain.

Objective: One possible mechanism behind post-stroke shoulder pain is inflammation in the subacromial bursa, a bursa located just above the shoulder joint. Thus, it is reasonable to inject this bursa with corticosteroids, a powerful anti-inflammatory medication. Many physicians already prescribe subacromial corticosteroid injections for the treatment of post-stroke shoulder pain. However, there is very limited evidence in the scientific literature regarding its efficacy in the stroke population. Moreover, the exact dose that should be used is not known. Thus, in this study, stroke survivors with shoulder pain are randomly assigned to 3 treatment doses: low dose, standard dose and high dose. This is a double-blinded study, which means that neither the participant nor the physician performing the injection know which dose is being injected. After the injection, participants’ shoulder pain is monitored by telephone every month for 3-mo. After all participants complete their pain assessments, a code that identifies which participant received which dose will be “broken” to determine which dose, on average, was most effective.

Detailed program information and criteria available at:
http://clinicaltrials.gov/ct2/show/NCT00597766

 

Principal Investigator: John Chae, M.D.
Contact: Peggy Maloney, R.N.
Contact Number: (216) 957-3558
Contact Email: mmaloney@metrohealth.org

 


Intramuscular Electrical Stimulation for Post-stroke Shoulder Pain

Purpose: Compare the efficacy of intramuscular electrical stimulation to “usual care” for the treatment of post-stroke shoulder pain.

Objective: One mechanism responsible for shoulder pain following stroke is weakness of the muscles surrounding the shoulder joint. Surface electrical stimulation has been shown to reduce shoulder pain. However, due to the discomfort of long-term use of surface electrical stimulation, investigator at the FESC investigators developed a technique where electrodes are temporarily implanted directly into muscles. FESC investigators demonstrated that this technique is well tolerated by stroke survivors and is superior to a shoulder sling in reducing shoulder pain. However, this technique now needs to be compared to “usual care,” which consists of elements of standard occupational and physical therapies. Stroke survivors with shoulder pain will be randomly assigned to receive the electrical stimulation therapy over a 4-wk period or standard occupational/physical therapy over the same time period. Shoulder pain will be monitored during the treatment period and over the following 3-mo by a study personnel who does not know the treatment assignment. After all participants complete their pain assessments, a code that identifies which participant received which treatment will be “broken” to determine which treatment was more effective.

Detailed program information and criteria available at:
http://clinicaltrials.gov/ct2/show/NCT01123382 

 

Principal Investigator: John Chae, M.D.
Contact: Peggy Maloney, R.N.
Contact Number: (216) 957-3558
Contact Email: mmaloney@metrohealth.org