Shoulder pain following stroke is a major rehabilitation problem affecting approximately 60% of moderate to
severely impaired stroke survivors. While many treatments for HSP have been proposed, most do not result in
long-term relief of pain. Our long-term goal is to develop a therapeutic intervention to reduce pain related to HSP.
In a systematic review of randomized controlled trials, intramuscular peripheral nerve stimulation (PNS),
developed by our research group, was the only treatment to provide long-term relief of pain for those with HSP.
Our recent pilot RCT compared PNS to physical therapy (PT) and 67% vs. 25% of participants experienced
successful pain relief (i.e., = 2-pt or 30% reduction) from PNS and PT, respectively. Although PNS produced
better outcomes than PT, there was still a large percentage of non-responders (50%) in the study. Furthermore,
amongst responders, pain relief was incomplete in 63% of the PNS group and 100% in the PT group. Yet, both
treatments did produce pain relief in a significant number of participants. Thus, a complementary, multimodal
treatment of PNS + PT may increase the percentage of patients who experience significant pain relief and will
produce a greater reduction in pain than with PNS or PT alone. The primary objective of this study is to determine
if multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. The
secondary objective is to investigate mechanisms of pain reduction by PNS and PT. In order to accomplish these
objectives, the investigators designed a multi-site, placebo controlled, double-blinded RCT to determine if
multimodal treatment of HSP with PNS + PT is more efficacious for pain relief than PNS or PT alone. Measures
of pain, pain interference with ADLs, QoL, shoulder biomechanics (shoulder abduction torque, shoulder
kinematics, and Fugl-Meyer score), and measures of central sensitization (pain thresholds, secondary
hyperalgesia, and temporal summation) will be measured. Participants will be followed for a total of 24 weeks
after treatment has concluded.