A stroke occurs when normal blood supply to the brain is interrupted,
preventing brain tissue from getting oxygen and nutrients.
Pain is one of the most poorly understood complications after a stroke.
It's also commonly underreported, underdiagnosed, and undertreated.
Yet it's estimated to affect about 30 to 40% of stroke survivors.
Patients often lack information about post-stroke pain and
may stop treatment too early.
General symptoms of post-stroke pain include numbness, tingling,
burning, aching, decreased range of motion, and a change in skin color.
Certain characteristics and behaviors have been identified as risk factors
for developing post-stroke pain.
Being a woman and having had a stroke at an older age, alcohol
use, staten use, depression and peripheral vascular disease.
Post-stroke conditions such as spasticity, reduced upper extremity movement, sensory
deficits and survivors of ischemic stroke.
Let's take a look at the different types of post-stroke pain.
Central post-stroke pain is a chronic painful condition that typically develops
three to six months after a stroke and affects seven to 8% of stroke survivors.
It's a constant pain caused by an injured pain nerve and is described as a burning
sensation or aching or shooting pains.
The entire pain system acts as a nerve ending and sometimes just a light
touch can cause an intense episode.
Headaches and stroke survivors are not well understood and can affect
between six to 44% of stroke patients.
Most are tension type headaches or moderate to severe and
can become chronic in nature.
Spasticity is a common condition after a stroke, affecting 25 to 43% of
survivors, muscles can become stiff, tighten up and resist stretching.
This results in spontaneous, painful spasms and night cramps.
Sometimes the muscle tone becomes so reduced that joints like an arm, hand,
wrist or toes get stuck in one position.
This is known as contracture, about 60% of stroke patients experienced
contractors, which can make activities such as grooming, dressing,
standing, and walking difficult.
Shoulder pain may also be experienced after a stroke.
During the first year, it can affect one to 22% of stroke survivors.
Shoulder pain can interfere with recovery, slow rehabilitation
and cause significant distress.
Diagnosis of post-stroke pain include clinical history and physical examination.
Patients must report symptoms in three of the following four pain categories.
Increased sensitivity, skin color changes, asymmetrical sweating on different sides
of the body and decreased range of motion.
They must also experience continuous pain on the affected side following stroke.
Treatment of post-stroke pain includes several different options.
Physical therapy can help stroke survivors relearn simple motor
activities, such as walking, sitting, standing, and lying down.
Occupational therapy, which involves exercise and training helps stroke
survivors relearn everyday activities.
This includes eating, drinking, and swallowing, dressing,
bathing, cooking, reading, and writing, and using the toilet.
The overall goal is greater independence.
Botulinum toxin is an injectable treatment that temporarily relaxes
stiff muscles after a stroke.
Applying electrical current through electrodes placed on the
skin can reduce pain signals.
This can include deep brain stimulation and motor cortex stimulation.
Appropriate treatment depends on a number of factors, including the severity of the
stroke and the type of pain experienced.
Treating post-stroke pain with prescription medication has
generally not been very effective.
Their use should be tailored to the patient's needs, their response
to therapy and any side effects.
Surgical treatment for survivors who have damaged nerves after a stroke
can reduce their pain by 50% or more.
The appropriate treatment depends on a number of factors, such as the severity
of the stroke and the type of pain.
The most important thing you can do if you experienced post-stroke pain is
talk with your healthcare professional.
Keep your followup appointments, follow the recommended treatment and management.
Talk to your doctor before making any changes and make it clear
that the pain you are experiencing only started after your stroke.