Post Stroke Pain

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Post Stroke PainPost Stroke Pain: is pain the patient experiences immediately after a stroke. First the pain sometimes occurs in the following weeks or months after a stroke.

As such there are two different types of stoke pain:
Local– impairment to muscle or soft tissue. Generally, this occurs in the joints.
Central-post stroke pain is identified by timid to harsh discomfort.

Following a stroke the brain cannot comprehend the signals sent by the body including reaction to touch, warmth, cold and others. The body now understands these as hurtful things.

Consequently symptoms of this condition include non-stop pain, reoccurring pain, pain felt on the affected side of the body, pain in the face, legs, arms or torso, and throbbing/hot/stinging pain.

As a result individuals may stop moving painful body parts allowing their muscles to become lethargic.

Treatments for pain following a stroke are:
Anti-depressants – which help alleviate the physical pain.
Surgical techniques include deep brain stimulation and motor cortex stimulation. Counseling may also be of great help.

Consequently what kinds of pain might I feel after stroke? 

Headache 

These are more common after haemorrhagic stroke than ischaemic stroke. Consequently it is not always known what causes headaches, but it can sometimes be a side affect of medications.

Shoulder pain and other musculoskeletal problems 

  • High tone (also called hypertonia or spasticity) means having a high amount of tension in your muscles. If you have high tone your muscles will be very stiff or tight.
  • Contracture means that muscles or joints become shorter or less flexible. This may happen if there is muscle weakness or high muscle tone that limits the movement in your arm or leg.
  • Shoulder subluxation caused by weak muscles allowing the top of your arm to slip out of the shoulder socket slightly. Some people will feel shoulder pain and other musculoskeletal pain without any of these causes. See the Upper limb movement after stroke fact sheet for more information.

 

Pharmacological Management

Consequently your doctor is the best person to determine if medication may help with your pain. Sometimes medications prescribed by your doctor will interact with other medications including overthe-counter medications or herbal remedies. As such it is important that you talk to your doctor or pharmacist about all the medications you are taking. This includes natural remedies or vitamin supplements. here are many types of medications that may help depending on the type of pain you feel. Such as:

  • Non-steroidal anti-inflammatories and paracetamol. To help to reduce inflammation.
  • Opioids. These act like hormones your body produces to reduce pain.
  • Anti-depressants. These change the amount of specific chemicals in your brain and ‘dampen down’ the pain messages and may be useful for CPSP. Anti-epileptic medications. To reduce excess electrical activity in the brain which can be associated with neuropathic pain and may be useful for CPSP.

Non-Pharmacological Management 

  •  Psychological techniques. Aim to change thoughts, beliefs and behaviours related to pain. This might include cognitive behavioural therapy (CBT), hypnosis, attention-diversion strategies, biofeedback or stress management and relaxation techniques.
  • Transcutaneous electrical nerve stimulation (TENS). This may be useful for CPSP and shoulder pain.
  • Exercise. Your therapist may recommend exercises, positions and supportive devices to help support a painful shoulder or arm.
  • Keeping active. This is important. Being active releases endorphins in your body. Endorphins are naturally occurring pain reducing substances in the body. Try to exercise or be active within your own limits, and talk to your general practitioner or physiotherapist before beginning a new exercise program.
  • Such as eating a healthy diet. Also limiting the use of tobacco, alcohol and caffeine.
  • Finally a Specialist pain management team. Consequently if the pain doesn’t resolve within a few weeks, your doctor may refer you to a specialist pain team. This is a group of health professionals who specialise in assessing and managing complex or chronic pain problems.

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