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Stroke Smart Magazine

March/April 2007

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Pain Doesn't Have to be Part of Stroke Recovery

By Pete Lewis

A young man describes his past year as one of constant pain. An elderly lady says she has trouble dressing and bathing herself because the pain in her shoulder is so bad. Another woman claims it hurts when her husband gently caresses her face. These are just some examples of what you might hear at a stroke survivor support group when the conversation turns to the topic of pain.

A stroke can cause pain in a number of ways. The pain can be mildly uncomfortable or so severe that it hinders recovery. In some cases, the pain is constant. In others, the pain comes and goes. Sometimes pain appears right after a stroke. But, it is not uncommon for pain to appear weeks or even months after the stroke. Some survivors suffer from more than one type of pain, each with a different cause and different symptoms.

But whatever the cause, symptoms or severity, stroke-related pain should never be ignored.

“Sometimes we're so concerned about regaining movement and the abilities we've lost after a stroke that we ignore the pain or see it as secondary,” said Pamela Bennett, BSN, RN, who has worked in pain management for 15 years. “It's important to understand that relieving pain often is part of recovery.”

And like so many aspects of recovery, communication is the most important weapon in combating stroke-related pain. It's essential for stroke survivors to discuss with, and describe their pain to, their doctors and caregivers.

“There are a wide variety of causes,” said Dr. Richard Zorowitz of the Department of Physical Medicine and Rehabilitation at Johns Hopkins University and head of the Rehabilitation & Recovery Advisory Board for National Stroke Association. “So, the first step is to identify the root cause of the pain. Patients need to communicate with their doctors about the location of the pain, if it's constant, when the pain feels better or when it feels worse, what makes it feel better and what makes it feel worse.”

Unfortunately, many stroke survivors are reluctant to discuss their pain.

“Patients may report everything about their condition except their pain because they don't want to appear weak or whiny or to be a bother,” Bennett said. “They can be fearful or ashamed. Often, people don't even know how to talk about their pain.” Bennett said that men especially may think that talking about pain is a sign of weakness. But doctors can't treat pain without the patient's help. Bennett recommends that patients keep a “pain diary” to record information about their pain.

After talking to and examining you, your doctor will have a better idea how to treat your pain.

If your pain is the result of damage to muscle or other soft tissue, called mechanical pain, you may be treated with medicine and physical or occupational therapy. This type of pain is generally caused by lack of use, from the unusual positioning of a joint or from spasticity, a common condition in which certain muscles are always flexed. It usually feels like an aching pain deep within the body, or a dull or throbbing pain. Mechanical pain often responds well to exercise, stretching and physical therapy. Your doctor also may prescribe pain killers. Spasticity-caused pain may be treated with anti-spasticity medicine.

On the other hand, your pain may be caused by damage to the brain or nervous system. Sometimes after a stroke, the brain may misinterpret signals it receives from another part of our body. For example, a light touch to your arm may be interpreted as painful or unpleasant. Neurological or nerve-related pain may feel like a burning or tingly, like you've hit your funny bone. It can be harder to treat.

“Nerve-related pain may require some trial and error before we find the right drug or combination of drugs,” Zorowitz said. “Often a patient has to be on a certain drug for several weeks before it takes effect, so it can be frustrating. Treatment requires a lot of patience.”

Another common pain among stroke survivors is shoulder pain. About three of every four survivors have pain in the shoulder some time after their stroke. This pain, sometimes called frozen shoulder, usually is treated with some combination of hot and cold compresses, physical therapy and pain-relieving drugs.

Sometimes your doctor will refer you to a psychologist or counselor. Just as pain affects your emotional state, your emotions influence your pain. Zorowitz said stroke-related pain may lead to depression, but that depression also can make the pain worse.

Treating stroke-related pain may require a few weeks or years. Sometimes the pain doesn't completely disappear. But, it is always possible to make the pain more manageable.


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