Pain is a frequent but still poorly studied long term consequence of stroke. Sometimes it can even be a “good” sign, telling that sensation is returning to a previously numb part of the body. In a recent paper, the prevalence and intensity of pain was evaluated. It was found that 4 months after stroke onset, one third of patients were complaining of moderate to severe pain, and that 1 year later, one fifth were still experiencing moderate to severe pain and that the intensity of the severe pain had increased.

The precise cause of post-stroke pain is unknown, although it may be due to a hyperactivity of the autonomic nervous system. Because the brain has been damaged, it feels pain when it should be feeling a sensation that is not painful. One major problem is that painkillers have no effect on this type of pain.

Patients may experience one type of pain or several kinds. The key is to figure out what is causing the pain so that the patient can treat it. There are basically two kinds of pain after stroke:

Central pain is constant, moderate or severe. It tends to be felt in one part of the body, usually an arm or a leg. It is always on the side of the body affected by the stroke. Central pain is produced within the brain as a result of the stroke. It does not stem from damaged nerve endings. Rather, the body sends normal messages to the brain in response to touch, warmth, cold and other stimuli. But the brain does not understand these signals correctly. Instead, it will register even slight sensations on the skin as painful.

To find a way of relief, patients should explain their symptoms to the doctor. Together, they can determine the best treatment. Patients could already try some solutions when at home. A start is to avoid things that can cause pain, such as hot baths, tight or easily bunched clothing, and pressure on the side of the body affected by the stroke. While sitting or lying down, support the paralyzed arm on an armrest or pillow to relieve shoulder pain from the arm’s weight; the same should be done with a sling while walking. At last, patients could use heart packs or simple exercises prescribed by their physical therapist.

What else can help besides asking the doctor? First of all, focus on thoughts or activities that are enjoyable. Patients can and should still be active, productive and have a good quality of life. Relaxation, meditation or hypnosis can also help to manage the pain. Secondly, finding and joining an adequate stroke support group. Other survivors will understand and validate the issues and offer encouragement and ideas for pain relief. At last, speaking honestly and openly with the care giver about the pain issues, who will be glad the patient did so, and together work out the best solution.

Further research will hopefully precisely evaluate the various mechanisms of pain and the impact of medications and non pharmacological treatments. So that pain after stroke will be no longer neglected because of its high prevalence.

Sources:
National Stroke Association
Journal of Neurology, Neurosurgery & Psychiatry