Repetitive Transcranial Magnetic Stimulation in Hemiplegic Shoulder Pain

Shoulder pain after stroke is one of the most common complications of stroke. Underlying mechanisms of shoulder pain after stroke still completely is not clarified. Central sensitization and neuropathic pain mechanisms are thought to play a role in the etiology of pain. Research on repetitive transcranial magnetic stimulation therapy in the treatment of pain in which somatosensory sensitization mechanisms play a role is increasing day by day. There are studies showing that application of high-frequency rTMS to the primary motor cortex provides effective pain relieving in most of painful conditions. However, data in the literature regarding the application of high-frequency rTMS in shoulder pain after stroke are very limited. There is only one clinical study related to this. More studies are needed in this area.In our study, it was aimed to examine the effects of this treatment protocol applied on the effects of pain on daily activities, upper extremity disability, anxiety, depression, range of motion and neurophysiological parameters.

Inclusion Criteria:Being between the ages of 18-70Presence of ischemic or hemorrhagic stroke confirmed by MRIHaving a stroke for the first timePresence of stroke in the subacute or chronic periodPresence of subacute or chronic shoulder pain starting after stroke and Numeric Rating Scale >4If the patient is receiving analgesic treatment, the pain persists despite at least one week of analgesic treatment.Patients who agreed to participate by signing the informed permission form.Exclusion Criteria:Presence of history of surgical intervention on the shoulder jointPresence of history of peri/intraarticular injection into the shoulder jointRotator cuff injury or tendonitis, frozen shoulder, etc. that they had diagnosed/treated before strokePresence of full-thickness rotator cuff tear visualized by USPresence of >3 spasticity in the upper extremity defined according to the Modified Ashworth ScalePresence of severe cognitive impairmentPresence of aphasiaHistory of malignancy or systemic rheumatic diseaseAlcohol or drug addictionHistory of psychiatric illness such as major depression/personality disordersHistory of epilepsy or taking medication due to epilepsyDiagnosed with dementiaPregnancy and breastfeedingHaving received TMS treatment beforeHaving a clinical condition (metallic implant, cardiac pace, head trauma, cranial operation history…) that would be a contraindication for TMS