Multimodal Treatment for Hemiplegic Shoulder Pain

Inclusion Criteria:

• shoulder pain localized to the glenohumeral joint, subacromial area or deltoidinsertion associated with: a) rest; b) passive abduction or external rotation rangeof motion (ROM); c) active abduction ROM; or, d) manual palpation;

• shoulder pain onset or worsening after the most recent stroke;

• weakness of shoulder abductors (≤4/5 on Medical Research Council (MRC) scale ifisolated movement is present);

• ≥ 21-yrs old; < 90-yrs old;

• time of stroke ≥ 3-mo;

• duration of HSP ≥3-mo;

• HSP with moderate to severe pain (BPI SF-3 ≥ 4);

• cognitive and communication ability to fulfill study requirements (cognitive abilitybased upon a score of ≥24 on the Mini Mental Status Exam (MMSE));

• availability of reliable adult who can assist with study procedures if necessary;

• willing and able to report shoulder pain and other conditions and complete studyvisits throughout the 4 month study period.

Exclusion Criteria:

• joint or overlying skin infection or history of recurrent skin infections;

• insensate skin;

• need to take > 1 opioid and > 1 nonopioid analgesic medication for HSP;

• regular intake of pain medications for another chronic pain;

• botox injection or subacromial steroid injections to the shoulder within the past 12weeks;

• receiving occupational therapy (OT) or PT for HSP;

• bleeding disorder or international normalized ratio (INR) > 3.0;

• sensitivity to skin surface electrodes and/or medical-grade adhesives, gels, tapes;

• medical instability;

• pregnancy;

• uncontrolled seizures (>1/mo for 6-mo);

• history of cardiac arrhythmia with hemodynamic instability;

• history of lidocaine allergy;

• history of Parkinson's disease, spinal cord injury (SCI), traumatic brain injury (TBI), multiple sclerosis (MS), or ipsilateral upper extremity (UE) lower motorneuron lesion;

• history of complex regional pain syndrome, myofacial pain syndrome, other painconditions (investigator discretion);

• cardiac pacemaker or other implanted electronic device;

• history of valvular heart disease (artificial valves, requiring antibiotics forprocedures, etc.);

• severely impaired communication.