Repetitive Transcranial Magnetic Stimulation in Hemiplegic Shoulder Pain
Post-stroke Shoulder Pain
About this trial
This is an interventional treatment trial for Post-stroke Shoulder Pain focused on measuring Stroke, Shoulder pain, Repetitive transcranial magnetic stimulation
Eligibility Criteria
Inclusion Criteria: Being between the ages of 18-70 Presence of ischemic or hemorrhagic stroke confirmed by MRI Having a stroke for the first time Presence of stroke in the subacute or chronic period Presence of subacute or chronic shoulder pain starting after stroke and Numeric Rating Scale >4 If 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 joint Presence of history of peri/intraarticular injection into the shoulder joint Rotator cuff injury or tendonitis, frozen shoulder, etc. that they had diagnosed/treated before stroke Presence of full-thickness rotator cuff tear visualized by US Presence of >3 spasticity in the upper extremity defined according to the Modified Ashworth Scale Presence of severe cognitive impairment Presence of aphasia History of malignancy or systemic rheumatic disease Alcohol or drug addiction History of psychiatric illness such as major depression/personality disorders History of epilepsy or taking medication due to epilepsy Diagnosed with dementia Pregnancy and breastfeeding Having received TMS treatment before Having a clinical condition (metallic implant, cardiac pace, head trauma, cranial operation history…) that would be a contraindication for TMS
Sites / Locations
- İzmir Katip Çelebi Üniversitesi
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Active stimulation group
Sham stimulation group
Patients in the real stimulation group will receive rTMS treatment to the motor cortex (M1) of the affected hemisphere at a frequency of 5 Hz, once a day for 3 weeks and a total of 15 sessions. The application will be performed with Neurosoft-Neuro MS / D device. Before each session, the patient's resting motor threshold (RMT) value will be determined. RMT will be detected by obtaining a motor evoked potential of >50 μV amplitude on electromyography recording of the contralateral first dorsal interosseous muscle in at least five out of 10 stimulations to the primary motor cortex.The stimulus intensity to be used in the treatment will be set as 90% of the motor threshold for the affected motor cortex and 100% of the motor threshold for the unaffected motor cortex.One session of stimulation will last for a total of 20 minutes and a total of 1000 pulses in the form of 5 Hz stimulation.
Fifteen sessions of sham repetitive transcranial magnetic stimulation (rTMS) treatment will be applied to the lesional primary motor cortex. The application will be performed with Neurosoft-Neuro MS / D device. The probe of the device will be held perpendicular to the motor cortex and operated from the lowest operating power of 1, so that the device makes the same sounds as the active application.