Shoulder pain is among the most common and immediate effects of stroke, and Assistant Professor Deniz Dishman, PhD, DNAP, CRNA, will use a new grant from the PARTNERS organization to learn more about how the brain perceives such pain.
Dishman is an assistant professor in the Department of Research at Cizik School of Nursing at UTHealth Houston and leads the university’s Pain Management Program at the Institute for Stroke and Cerebrovascular Disease.
“Approximately 70 percent of stroke survivors report shoulder pain in the immediate period of stroke,” Dishman said. This “hemiplegic shoulder pain” or HSP, results from stroke-related mobility impairment due to damage to one side of the brain.
“Chronic HSP can lead to lengthened hospital stays, worsened outcomes, depression, and deconditioning,” Dishman said. “Effective treatment is critical for stroke survivors to participate in intensive physical therapy and realize the associated functional improvements.”
Dishman added that recent clinical trials have shattered the longstanding idea that patients experiencing chronic HSP cannot improve their overall function. Rather, patients who receive therapy even six months to one year after surviving a stroke demonstrate long-term improvements in shoulder function. However, pain often prevents these patients from partaking in this necessary post-stroke treatments.
“Approximately 30% percent of HSP sufferers experience unmanageable pain that does not respond to traditional interventions including nonsteroidal anti-inflammatories, opioids, and therapy including strapping, acupuncture, and injections,” said Dishman.
Armed with this information, Dishman reached out to her co-investigator in the study, Sarah Prinsloo, PhD, at The University of MD Anderson Cancer Center. Prinsloo has successfully treated cancer patients who have undergone chemotherapy and reported chemotherapy induced neuropathic pain.
“We have learned that brain imaging such as electroencephalographic imaging (EEG) and functional MRIs visually demonstrate the nerve network underlying the subjective perception of pain, particularly in cancer patients who complain of pain, and patients with chronic lower back pain,” said Dishman. “So why not see if a similar approach would work to develop treatments for stroke survivors who develop similar pain?”
Her proposal, “Biomarkers Illuminating Pain After Stroke (BIPAS),” was recently selected for a $100,000 PARTNERS Nursing Research Award. Dishman and her team will use the funds to help identify shared spatial patterns on quantitative EEG brain mapping of patients with post-stroke shoulder pain.
To carry out the study, Dishman’s team will work collaboratively with the Prinsloo Laboratory at MD Anderson, which focuses on applied neuroscience, particularly the use of neuroimaging and noninvasive techniques. She will work closely with Sean Savitz, MD, professor, neurology chair, and director of the UTHealth Institute for Stroke and Cerebrovascular Diseases, who is also a co-investigator in this study. They will recruit stroke patients who have developed HSP from across the Texas Medical Center to participate in the study.
“Our long-term goal is to dually develop effective treatments for post-stroke pain and remove the barriers to intensive rehabilitation. This study is the first step in a long-term plan to provide important and timely evidence to advance pain assessment and interventions in stroke survivors and enable participation in critical rehabilitation,” said Dishman.
Other members of Dishman’s research team are Professor Charles Green, PhD, and Assistant Professor Mary E. Russell, DO, of McGovern Medical School; and Professor Xiaoqian Jiang, PhD, of the UTHealth Houston School of Biomedical Informatics.
PARTNERS (or Providing Advancement Resources To Nursing Education, Research, and Students) was founded in 1994 with the sole mission of raising funds to support faculty research and student scholarships at Cizik School of Nursing.