Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand sy
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Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand syndrome Marc Monsour 1 & Rosendo A. Rodriguez 2 & Adnan Sheikh 3 & T. Mark Campbell 4 Received: 20 July 2019 / Accepted: 9 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Current management options for pain in stroke patients with the shoulder-hand syndrome (SHS) are limited and often ineffective. The use of peripheral nerve blocking in SHS has been limited due to concerns of hyperalgesia and allodynia in these patients. This study assessed the tolerability of suprascapular nerve (SSN) and median nerve blocks for acute control of pain in patients with post-stroke SHS. Methods All SHS patients fulfilled diagnosis using the Budapest criteria. Patient tolerability was defined by a composite score that included a change on the visual analog scale (VAS) from baseline for shoulder and hand pain, presence of adverse events, and a selfreported patient satisfaction score. Pain assessment was performed 1 h before (baseline), and 1 h and 2 weeks after the procedure. Results Five patients (68.5 ± 9.5 years) with post-stroke SHS underwent SSN and median nerve blocks. Participant assessment 1 h after the procedure indicated that the 2 blocking procedures were well tolerated and that VAS scores for shoulder and hand pain decreased by 79% (− 62.6 mm ± 25.6; p = 0.043) and 48% (− 33 mm ± 40.2; p = 0.080), respectively from baseline. After 2 weeks, average VAS scores remained 56% and 37% below baseline, respectively. There were no adverse events and all patients were satisfied after the procedure. Conclusions Suprascapular and median nerve blocks are safe and well-tolerated procedures for acute pain control in post-stroke SHS. Further studies should address the benefit of these procedures on overall pain reduction, functional recovery, and quality of life in SHS patients. Keywords Pain management . Shoulder-hand syndrome . Nerve block . Visual analog scale . Complex regional pain syndrome
Introduction Complex regional pain syndrome (CRPS) is a debilitating and painful disorder that occurs in 12% to 35% of patients with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04816-5) contains supplementary material, which is available to authorized users. * T. Mark Campbell [email protected] 1
Department of Medicine, Division of Physical Medicine and Rehabilitation, The Ottawa Hospital Rehabilitation Centre, ON Ottawa, Canada
2
Department of Medicine, The Ottawa Hospital and University of Ottawa, ON Ottawa, Canada
3
Department of Radiology, The Ottawa Hospital, ON Ottawa, Canada
4
Department of Physical Medicine and Rehabilitation, Elizabeth Bruyère Hospital, 43 Bruyère St, ON K1N 5C8 Ottawa, Canada
hemiplegic stroke [1]. In these patients, pain predominantly affects the shoulder and hand, a condition known as “shoulder-hand syndrome” (SHS). The pathophysiology of SHS is poorly understood [2], and the
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