4.5 Article

Changes in serum levels of pain mediators in hemiplegic shoulder pain

Journal

BRAIN AND BEHAVIOR
Volume -, Issue -, Pages -

Publisher

WILEY
DOI: 10.1002/brb3.3289

Keywords

calcitonin gene-related peptide; depression; hemiplegic shoulder pain; interleukin-10; interleukin-2; poststroke shoulder pain; spasticity; stroke

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This study provides new insights into the diagnosis and treatment of hemiplegic shoulder pain (HSP) by investigating changes in serum pain mediators. The results suggest that patients with HSP have a higher risk of joint mobility disorders and depression. Spasticity may play a significant role in the development of shoulder pain. Additionally, calcitonin gene-related peptide (CGRP) is believed to be the major pain mediator in HSP, indicating that HSP may not be inflammatory.
Objective: To provide a new insight into the diagnosis and treatment of hemiplegic shoulder pain (HSP) by investigating changes in serum pain mediators.Design: Cross-sectional study.Subjects/patients: Shoulder pain group (n = 34) and control group (n = 21).Methods: Pain-free shoulder mobility, anxiety status, depression status, and shoulder pain were measured by passive range of motion (PROM), self-rating anxiety scale, self-rating depression scale (SDS), and visual analog scale, respectively. The enzyme-linked immunosorbent assay was used to test the serum pain mediators, including interleukin (IL)-1 beta, IL-2, IL-6, IL-10, nerve growth factor (NGF), tumor necrosis factor-alpha (TNF-alpha), substance P (SP), calcitonin gene-related peptide (CGRP), bradykinin (BK), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2), and lysophosphatidic acid (LPA).Results: Shoulder pain group pain-free PROM significantly lower than control (p < .01), and SDS index score of shoulder pain group was significantly higher than control (p < .05). The rate of spasticity in the flexor elbow muscles is higher in shoulder pain group (p < .01). CGRP, IL-10, and IL-2 were significantly upregulated in shoulder pain group compared with control (p < .01), whereas NGF, TNF-alpha, IL-6, 5-HT, PGE2, SP, LPA, BK, and IL-1 beta were significantly decreased (p < .01).Conclusion: Patients with HSP have a higher risk of joint mobility disorders and depression; spasticity may be an important factor in the development of shoulder pain; CGRP is thought to be the major pain mediator in HSP, and HSP may not be inflammatory.

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