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The mechanism of <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> is not clearly understood; hence, it is unclear why <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> resolves spontaneously or following routine care in some patients, while in others it becomes persistent. The aim was therefore to study whether <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> is associated with deficient pain modulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty post\u2010stroke patients\u201416 with <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> and 14 without <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content>\u2014and 20 matched controls participated. Pain adaptation and conditioned pain modulation (<jats:styled-content style=\"fixed-case\">CPM<\/jats:styled-content>) were measured as indicators of pain modulation, in the affected (hemiplegic) and contralateral shoulder as well as in the affected shin among post\u2010stroke patients, and in comparable body regions among controls. Post\u2010stroke patients also underwent functional and physical evaluation of the shoulder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Pain adaptation was absent among <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> patients, in both the painful shoulder and the affected shin, but existed in the 2 control groups. In addition, the affected shoulder and shin among the <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> group had reduced thermal sensibility compared to the contralateral regions. <jats:styled-content style=\"fixed-case\">CPM<\/jats:styled-content> was similar across groups. Shoulder functional status and physical status were similar for the 2 post\u2010stroke groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results suggest that <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> is associated with a lack of pain adaptation, characteristic not only of the painful shoulder but also of the affected side. Although we cannot determine whether lack of pain adaptation precedes the <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> or results from it, interventions that enhance descending pain inhibition may improve management and prevent <jats:styled-content style=\"fixed-case\">HSP<\/jats:styled-content> chronification.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12658","type":"journal-article","created":{"date-parts":[[2017,11,14]],"date-time":"2017-11-14T16:37:45Z","timestamp":1510677465000},"page":"716-728","source":"Crossref","is-referenced-by-count":10,"title":["Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain"],"prefix":"10.1111","volume":"18","author":[{"given":"Yafit","family":"Kashi","sequence":"first","affiliation":[{"name":"Department of Physical Therapy Loewenstein Rehabilitation Hospital Raanana Israel"},{"name":"Department of Physical Therapy Sackler Faculty of Medicine Tel\u2010Aviv University Tel\u2010Aviv 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