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Post Stroke Pain

Definition

Pain that follows a stroke is termed post-stroke pain. Stroke (a cerebrovascular accident, or CVA) is the leading cause of long-term disability in adults. Most strokes do not cause pain, only numbness. However, sometimes this numbness is accompanied by a deep burning, pins and needles sensation and often by muscle contraction.

Causes

The precise cause of post-stroke pain is unknown, although it may be due to a hyperactive autonomic nervous system. Because the brain has been damaged, it feels pain when it should be feeling a sensation that is not painful. Common painkillers have no effect on this type of pain. Twenty percent of patients with this condition get better over a period of years. In 30 percent of these individuals, the pain decreases during the first year.

Risk Factors

The overall best prevention for post-stroke pain is prevention of the stroke itself. According to the National Stroke Association, 80% of all strokes can be prevented. A focus on healthy lifestyle choices can reduce the likelihood of stroke, by eliminating risks such as obesity, high blood pressure, high cholesterol, uncontrolled diabetes, and smoking.

Symptoms

The onset time for symptoms to develop is variable, ranging from days to years after the stroke. Pain can be felt in the face, arm, leg and trunk on the stroke side. Some patients have symptoms affecting the whole side of the body. The pain has been described as burning, aching or pricking in nature. It is usually constant and increases in intensity over time. Movement, changes in temperature or other unrelated stimuli may aggravate the symptoms. The pain is often accompanied by abnormal sensations in the affected body part.

Diagnosis

Pain following a stroke may not be immediately evident. However, as weeks go by stroke survivors can experience chronic pain resulting from sensory nerve damage and also from intense muscle spasms/contractures.

Treatment

Some fortunate stroke survivors with chronic pain have experienced spontaneous remission; the pain disappears for no apparent reason. But for many, there is a long and arduous recovery period that entails re-learning the simple tasks of daily living such as eating, dressing, or even speaking as well as trying to accommodate the pain.
Identifying the type or source of the pain determines the recommended treatment.

For joint pain:

  • Movement, and sometimes heat, can be helpful in relieving discomfort.
  • A physical therapist can teach mobility exercises for a paralyzed limb to you and a family member, minimalizing frozen joint syndrome and the pain related to it.

For neuropathic pain:

  • Sympathetic nerve blocks
  • Trial neuromodulation
  • Spinal cord stimulation can sometimes be helpful

For muscle spasticity:

  • Physical therapy may be used to alleviate or prevent muscle spasticity, or atrophy. Passive movement of a paralyzed limb is essential to prevent painful "freezing" of the surrounding tissues and to allow easy movement if and when voluntary motor strength returns.
  • Botox and simple local anesthetic injections may be used to block overactive nerve impulses and in turn inhibit excessive muscle contractions.
  • Oral medication such as Baclofen may be prescribed to treat the general effects of spasticity.
  • Complementary treatments such as nutritional therapy, acupuncture, and hypnosis may be useful.
  • For severe refractory cases, implant technology such as pumps/catheters for intraspinal and spinal cord/dorsal column stimulation can be considered.

Prevention

The overall best prevention for post-stroke pain is prevention of the stroke itself. According to the National Stroke Association, 80% of all strokes can be prevented. A focus on healthy lifestyle choices can reduce the likelihood of stroke, by eliminating risks such as obesity, high blood pressure, high cholesterol, uncontrolled diabetes, and smoking.

 

Dr. Kailash Kothari
Director

+91 - 93200- 27500

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