Electrical stimulation for preventing and treating post-stroke shoulder pain

 

Abstract

Background

Shoulder pain after stroke is common and disabling. The optimal management is uncertain, but electrical stimulation (ES) is often used to treat and prevent pain.

Objectives

To determine the efficacy of any form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke.

Search methods

We searched the Cochrane Stroke Review Group trials register and undertook further searches of MEDLINE, EMBASE and CINAHL. Contact was established with equipment manufacturers and centres that have published on the topic of ES.

Selection criteria

We considered all randomised trials that assessed any surface ES technique (functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) or other), applied at any time since stroke for the purpose of prevention or treatment of shoulder pain.

Data collection and analysis

Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data.

Main results

Four trials (a total of 170 subjects) fitted the inclusion criteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no significant change in pain incidence (Odds Ratio (OR) 0.64; 95% CI 0.19 to 2.14) or change in pain intensity (Standardised Mean Difference (SMD) 0.13; 95% CI -1.0 to 1.25) after ES treatment compared to control. There was a significant treatment effect in favour of ES for improvement in pain-free range of passive humeral lateral rotation (Weighted Mean Difference (WMD) 9.17; 95% CI 1.43 to 16.91). In these studies ES reduced the severity of glenohumeral subluxation (SMD -1.13; 95% CI -1.66 to -0.60), but there was no significant effect on upper limb motor recovery (SMD 0.24; 95% CI -0.14 to 0.62) or upper limb spasticity (WMD 0.05; 95% CI -0.28 to 0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder.

Authors' conclusions

The evidence from randomised controlled trials so far does not confirm or refute that ES around the shoulder after stroke influences reports of pain, but there do appear to be benefits for passive humeral lateral rotation. A possible mechanism is through the reduction of glenohumeral subluxation. Further studies are required.

 

Plain language summary

Electrical stimulation for preventing and treating post-stroke shoulder pain

Electrical stimulation of muscles improves shoulder stiffness after a stroke but there is not enough evidence to prove whether it reduces shoulder pain. Patients who have a stroke (a sudden catastrophe in the brain either because an artery to the brain blocks, or because an artery in or on the brain ruptures and bleeds) often develop shoulder pain. This adds to the difficulties caused by the stroke. Pain in the shoulder can cause weakness, loss of muscle tone and loss of feeling. Electrical neuromuscular stimulation (ES) is done by applying an electrical current to the skin. This stimulates nerves and muscle fibres and may improve muscle tone, muscle strength, and reduce pain. The review found that shoulder stiffness improved after ES. No adverse effects were noted. The review also found there was not enough evidence to decide if ES can reduce shoulder pain or not. More research is needed.

 

摘要

背景

使用電刺激於預防與治療中風後病人的肩部疼痛

中風後的肩部疼痛是常見的並且會造成殘障。最佳的處理方式並未確定，但是電刺激(ES)常被用來治療以及預防疼痛。

目標

此回顧論文的目的是確定任何形式的體表電刺激在中風後的任何時間，對於預防與/或治療肩部附近疼痛的效力。

搜尋策略

我們搜尋Cochrane Stroke Review Group trials register並進一步著手搜尋MEDLINE，EMBASE 與 CINAHL。我們與儀器製造商以及曾經發表過關於電刺激這個主題的醫學中心建立聯繫。

選擇標準

我們考慮所有的隨機試驗(randomised trial)，以評估應用在中風後的任何時間，以預防或治療肩痛為目的的任何體表電刺激技術(功能性電刺激(FES)，經皮神經電刺激(TENS)或其他)。

資料收集與分析

兩位檢閱者各自選擇納入的試驗，評估試驗品質並篩選資料。

主要結論

4個試驗(共計170位受試者)符合納入條件。研究設計與電刺激技術有相當的變異，常造成合併研究的阻礙。研究的母數很小。在電刺激治療後疼痛的發生率(勝算比OR 0.64; 95% CI 0.19 to 2.14)或是疼痛程度的變化(標準平均差Standardized Mean Difference(SMD) 0.13; 95% CI −1.0 to 1.25)與對照組比較起來並沒有顯著的變化。有一項顯著的治療效果是有利於電刺激的 – 無痛性被動肱骨外旋角度的改善(加權平均差Weighted Mean Difference(WMD) 9.17; 95% CI 1.43 to 16.91)。在這些研究中電刺激減少了淺窩肱骨(glenohumeral)脫臼的嚴重程度(SMD −1.13; 95% CI −1.66 to −0.60)，但在上肢的運動功能復原(SMD 0.24; 95% CI −0.14 to 0.62)或是上肢的僵硬程度上(WMD 0.05; 95% CI −0.28 to 0.37)並沒有顯著的效果。電刺激作用在肩部上並沒有顯示任何負面的影響。

作者結論

從隨機對照試驗得到的證據目前為止並不足以證實或駁斥在中風後施予肩部附近電刺激會影響疼痛的報告，但那確實顯示對於被動性肱骨外旋有好處。一個可能的機轉是經由減少淺窩肱骨的脫臼。更進一步的研究是有需要的。

翻譯人

本摘要由奇美醫院陳軾正翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於肌肉的電刺激能改善中風後肩部的僵硬，但沒有足夠證據證明它是否能減少肩部疼痛。得到中風的病人(因為到腦部的動脈阻斷抑或是腦中或腦上面的動脈破裂出血而導致的突發性不幸事件)常會產生肩部疼痛。這增加了中風導致的困難。肩部的疼痛可以造成無力、肌肉張力喪失以及感覺喪失。神經肌肉電刺激(ES)是經由在皮膚上施加電流來執行。這刺激了神經及肌肉纖維，因此可能改善肌肉張力、肌力，以及減少疼痛。這篇回顧發現在使用ES之後肩部的僵硬改善了。沒有記錄到不良作用。這篇回顧也發現沒有足夠的證據以判定ES是否可以減少肩部疼痛。更多的研究是被需要的。