Along with central post-stroke pain, spasticity, contractures and shoulder pain, complex regional pain syndrome (CRPS) type 1 is also a cause of physical suffering after stroke. It’s characterized by pain, edema, sudomotor and vasomotor changes mainly in the affected side (the shoulder and hand are usually involved), associated with bone demineralization.
The pathophysiology is still poorly understood. Biomechanical factors and microtrauma to the hemiparetic shoulder in association with somatic nervous system dysfunction, inflammation, hypoxia and psychological factors may have a contribution.
Hence, our main goal was to characterize the cases presented in the Neurology Ward of our hospital in order to better understand this pathology.
The patients’ mean age was 60,4 years [range, 46-79 years]. Seven were male, three were female. Mean time of onset 52,7 days after stroke [range, 39-87 days]. Six of the strokes were ischemic, two hemorrhagic, two were hemorrhagic transformations of ischemic events. Both cerebral hemispheres were equally affected. The majority (seven) had a middle cerebral artery stroke. Eight involved the upper limb, two upper and lower limbs (all in the hemiparetic side). Ten had hemihypesthesia. Clinical management was achieved through pharmacological and non-pharmacological measures.
Due to the small sample size, it is not possible to determine any patterns. However, apparently CRPS appears in the subacute stroke phase and commonly involves the upper limb on the hemiparetic side. This presentation aims to raise awareness to CRPS as a clinical condition associated with pain after stroke frequently underdiagnosed. There is no definitive treatment. Nevertheless an interdisciplinary approach is recommended. The use of medication combined with physical therapy and behavioral interventions may be appropriate.
Barbara Dantas Martins– Resident, Hospital Prof. Doutor Fernando Fonseca
Eduardo Freitas Ferreira– Physical Medicine & Rehabilitation Resident, Hospital Professor Doutor Fernando Fonseca
Diogo Portugal– Physical Medicine & Rehabilitation Resident, Hospital Professor Doutor Fernando Fonseca
Nuno Silva– Physical Medicine & Rehabilitation Resident, Hospital Professor Doutor Fernando Fonseca
Catarina Matos– Assistant, Hospital Professor Doutor Fernando Fonseca
Leonor Prates– Physical Medicine & Rehabilitation Specialist, Hospital Professor Doutor Fernando Fonseca