The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

Yong-Hui Zhang; Yu-Chen Wang; Gong-Wei Hu; Xiao-Qin Ding; Xiao-Hua Shen; Hui Yang; Ji-Feng Rong; Xue-Qiang Wang

doi:10.3389/fnins.2021.705516

The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients

Front Neurosci. 2021 Jul 30:15:705516. doi: 10.3389/fnins.2021.705516. eCollection 2021.

Authors

Yong-Hui Zhang¹, Yu-Chen Wang¹, Gong-Wei Hu², Xiao-Qin Ding², Xiao-Hua Shen², Hui Yang², Ji-Feng Rong², Xue-Qiang Wang^{1

3}

Affiliations

¹ Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.
² The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China.
³ Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China.

Abstract

Background: Somatosensory impairments and pain are common symptoms following stroke. However, the condition of perception and pain threshold for pressure stimuli and the factors that can influence this in individuals with stroke are still unclear. This study aimed to investigate the gender differences in pressure pain threshold (PPT) and positive somatosensory signs for pressure stimuli, and explore the effects of joint pain, motor function, and activities of daily living (ADL) on pain threshold in post-stroke patients.

Design: A cross-sectional study.

Methods: A total of 60 participants with stroke were recruited, and their pain condition, motor functions, and ADL were evaluated by the Fugl-Meyer assessment of joint pain scale, motor function scale, and Barthel index, respectively. PPTs in eight tested points at the affected and unaffected sides were assessed.

Results: Significant differences in PPTs were found between male and female patients in all measured muscles (p < 0.05). Positive somatosensory signs for pressure stimuli, including hypoalgesia and hyperalgesia, were frequently found at the affected side, particularly in the extremity muscles, but such signs were not significantly influenced by gender (p > 0.05). More equal PPTs between both sides and relatively lower PPTs at the affected side in the trunk and medial gastrocnemius muscles (p < 0.05) were observed in patients with less pain, better motor functions, and ADL.

Conclusion: Gender differences widely exist in post-stroke survivors either at the affected or unaffected side, which are multifactorial. Sensory loss and central and/or peripheral sensitization, such as hypoalgesia and hyperalgesia for pressure stimuli, caused by a brain lesion are common signs in male and female stroke patients. Moreover, patients who are in a better condition show a more symmetrical pain sensitivity between both sides in the trunk and in female lower extremities, indicating the bidirectional improvement of somatosensory abnormalities caused by a possible neural plasticity.

Keywords: hemiplegia; hyperalgesia; hypoalgesia; pain threshold; somatosensory; stroke.