Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review

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: The objective of this review was to determine the efficacy of a ny form of surface ES in the prevention and/or treatment of pain around the shoulder at any time after stroke. Search strategy: We searched the Cochrane Stroke Review Group trials regist er and undertook further searches of Medline, Embase and CINAHL. Contact wa s established with equipment manufacturers and centres that have published on the topic of ES. Selection criteria: We considered all randomized trials that assessed any s urface ES technique (functional electrical stimulation (FES), transcutaneou s 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 f or inclusion, assessed trial quality and extracted the data. Main results: Four trials (a total of 170 subjects) fitted the inclusion cr iteria. Study design and ES technique varied considerably, often precluding the combination of studies. Population numbers were small. There was no si gnificant change in pain incidence (odds ratio (OR) 0.64; 95% CI 0.19-2.14) or change in pain intensity (standardized mean difference (SMD) 0.13; 95% CI -1.0-1.25) after ES treatment compared with control. There was a signifi cant 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 1.43-16.91). In these studies ES reduced the severity of glenohumeral s ubluxation (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 -0.14-0.62) or upper limb spasticity (WMD 0.05; 95% CI -0.28-0.37). There did not appear to be any negative effects of electrical stimulation at the shoulder. Reviewers' conclusions: The evidence from randomized controlled trials so f ar does not confirm or refute that ES around the shoulder after stroke infl uences reports of pain, but there do appear to be benefits for passive hume ral lateral rotation. A possible mechanism is through the reduction of glen ohumeral subluxation. Further studies are required.