Pain following stroke can make the life miserable for patients who are already suffering because of disability. Stoke occurs due to an insult or injury to part of brain due to reduced blood supply. Stroke can leave with various physical effects like weakness, paralysis or changes in sensations. Unfortunately some patients also experience pain.
Pain can manifest in stroke patients as frozen shoulder, painful spasticity, persistent head ache, complex regional pain syndrome or as central post stroke pain (CPSP).
Central post-stroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. Approximately 5% of patients develop CPSP. This syndrome is characterised by pain and sensory abnormalities in the body parts that correspond to the brain territory that has been injured by the cerebrovascular lesion. The precise cause of the pain is unknown. In some cases it is due to damage to the thalamus; the brain’s ‘pain centre’. Because the brain is damaged it can sometimes feel pain when it should be feeling a sensation that is not painful. This is known as hypersensitivity or allodynia.
There is no cure for CPSP, but pain management helps patient to cope the pain better and improve the quality of life. Usual painkillers have little effect on this pain. Some medications originally developed for epilepsy and depression can have a positive effect. The most effective medicines are thought to be the tricyclic antidepressants such as amitriptyline. Stress and emotional upset can make CPSP much worse, so practising relaxation techniques such as meditation, visualisation or gentle yoga, can be very beneficial. TENS has been used in the management of CPSP, with variable results.