Vivek Rai, MD
Shoulder pain is a frequent complication in hemiplegic arm after stroke often attributed to multiple etiologic factors including biomechanical changes, spasticity and centrally mediated pain mechanisms. Suprascapular nerve block (SSNB) has been shown to be an effective treatment in arthritic conditions but its efficacy is hemiplegic shoulder pain (HSP) is largely speculative.
Adey-Wakeling et al undertook this rather small, randomized control trial (total patients randomized = 64) to study the efficacy of SSNB with methylprednisolone and bupivacaine in treatment of HSP. Visual analog scale was used for measurement of pain. Although there was marked placebo response (which is common in subjective outcome trials), pain reduction was superior and statistically significant with SSNB in comparison to sham injections during the 12-week study period.
SSNB is an emerging intervention for treatment of HSP and this is the largest randomized controlled trial in this field so far. The trial shows promising results. I will consider SSNB for pain control, like any other invasive procedure, only if other conservative treatments have failed. Also, this was a small trial with a short duration of follow up. A longer period of follow-up and, I suppose, repeat injections will be necessary in patients who find this intervention useful. It will be interesting to see this long-term data, which is also necessary to show this procedure as a practical and efficacious treatment for HSP over extended period of time.