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Stroke pain in the elderly can be caused by a variety of reasons, and the characteristics of complex underlying diseases, many complications, obvious functional disorders, and easy occurrence of adverse reactions in the elderly increase the difficulty
of pain diagnosis and treatment in clinical practice.
"Chinese Expert Consensus on Full-cycle Rehabilitation of Stroke Pain in the Elderly" focuses on five subtypes of common post-stroke pain in the elderly and the full-cycle rehabilitation management of stroke pain in the elderly.
.
Central pain after stroke (CPSP)
on the patient's history, physical examination, sensory tests, pain scores, and imaging.
Diagnostic criteria for CPSP recommended by Klit et al.
include:
(1) exclusion of pain from other causes; (2) The pain is located in the affected body part that is anastomosed with the lesion; (3) Have a history of stroke, and the pain occurs at or after the onset of stroke; (4) Clinical examination found signs consistent with lesions; (5) Neuroimaging examination found corresponding vascular lesions
.
Comply with the first 3 items as "possible CPSP"; Comply with one of the first 3 items and (4) or (5), which is "proposed CPSP"; All five were eligible for 'confirmed CPSP'
.
Spasticity-related pain
with pain.
Spasticity is identified by marked increased tone responsiveness with passive movement of the limb on physical examination, and spasticity-related pain if pain is present at the same time and there is no other explanation for the pain
.
Shoulder pain after stroke
to identify post-stroke shoulder pain.
The most common signs of shoulder pain after stroke are biceps tendon, supraspinatus tenderness, and positive Neer sign, which can be used as a basis
for diagnosis.
Complex regional pain syndrome (CRPS)
(1) persistent spontaneous pain
that is inconsistent with the primary stimulus.
(2) Have 3 or more of the following 4 groups of symptoms (at least 1 symptom in each group).
a.
Sensation: hyperesthesia and (or) paresthesia; b.
Vasomotor asymmetry: asymmetric skin temperature and (or) skin color change and/or color asymmetry; c.
Edema: edema and (or) abnormal sweating and (or) asymmetric sweating; d.
Exercise and nutrition: reduced range of motion of limbs or joints and/or motor dysfunction (tremor, dystonia) and/or nutritional changes (hair, nails, skin atrophy).
(3) Presence of at least 2 of the following 4 groups of signs (at least 1 symptom in each group): a.
signs of hyperalgesia (pinprick) or abnormal pain (light touch); b.
signs of skin temperature and/or color change or asymmetry; c.
Signs of sweating or edema changes, or asymmetrical sweating; d.
Signs of decreased range of motion and/or motor dysfunction and/or nutritional changes
.
(4) The above signs and symptoms
cannot be explained by other diagnoses.
Headache after stroke
(1) new headache after stroke; (2) headache is closely related to other symptoms of stroke, or directly leads to the diagnosis of ischemic stroke; (3) The degree of headache is significantly relieved with the stability or improvement of other symptoms of stroke, or relieved
with the stabilization or improvement of stroke imaging manifestations and clinical symptoms.
Compiled from: Geriatric Rehabilitation Professional Committee of Chinese Association of Rehabilitation Medicine, Community Working Committee of Chinese Association of Rehabilitation Medicine.
Chinese expert consensus on full-cycle rehabilitation of stroke pain in the elderly[J].
Chinese Journal of Stroke,2022,17(10):1040-1050.
