RE: Underlying Pathology and Associated Factors of Hemiplegic Shoulder Pain (Letter to the Editor)

Poststroke shoulder pain or hemiplegic shoulder pain (HSP) is a complex type of pain that has been the topic of many literature reviews. Traditionally, HSP is viewed as a nociceptive pain. Nonetheless, both the clinical features and the underlying mechanisms may show similarities to other types of poststroke pain, such as shoulder-hand syndrome (i.e., complex regional pain syndrome type 1) and central poststroke pain. As such, central pain mechanisms may play an important role in the development and in the perpetuation of HSP.1 In a recent literature review on the underlying pathology and associated factors of HSP, a theoretical framework was proposed, illustrating how altered peripheral and central nervous activity may contribute to the development of (persistent) HSP.2 According to the authors, however, convincing data on somatosensory sensitization were lacking at the time of the literature search (until September 2010). However, recently published data from our clinical research program indeed indicate an important role for somatosensory sensitization in HSP.3–5