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Stroke Smart Magazine


May/June 2009
FEATURE

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Recovery after Stroke:
Dealing with Pain

By Adam McVeigh

Survivors sometimes have to deal with pain caused by their strokes. For most people, pain is a sign that the body is being harmed in some way. That is not always the case after a stroke. Sometimes the stroke damage to the brain can make even normal touch feel painful. This is called central pain. In other cases, pain is felt because of muscle tightness or weakness. This type is called local pain.

Local Pain

This pain is felt in the joints. It often comes from the unusual positioning of a joint due to spasticity, a muscle tightness or stiffness common to stroke survivors.

Central Pain

This pain is constant, moderate or severe and wors­ened by touch, movement, emotions and changes in temperature. It tends to be felt in one part of the body, usually an arm or a leg and always on the side of the body affected by the stroke. You might not feel central pain in your body until weeks or months after a stroke.

Central pain 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. Instead, it registers even slight sensations in the skin as painful.

Stroke survivors with central pain might:

  • feel nothing when a sharp pin, warmth or cold is applied to their skin.
  • experience normal touch as unpleasant and painful.
  • feel more pain with emotional stress, cold or movement.
  • Chronic central pain can cause you to:
  • stop using the parts of your body where you feel pain.
  • allow muscles to weaken.
  • misuse drugs, suffer from depression, and/or increase dependency on family members.


Types of Pain after Stroke

You might experience one type of pain or several kinds. Pain after stroke can be:

  • mild, moderate or severe.
  • constant or on-and-off.
  • on part or all of the side of your body affected by the stroke.
  • felt in your face, arm, leg or torso.
  • aching, burning, sharp, stabbing or itching.

The key is to figure out what is causing the pain so that you can treat it.

Treating your Pain

Standard treatments to control chronic pain have limited success in stroke survivors. Neither over-the-counter nor prescription pain medicines have been effective in relieving stroke-related pain. Surgery has not provided much relief, although research con­tinues in this area.

Treatments that might help:

  • Antidepressant, anti-seizure and anti-spasticity drugs.
  • Treatment with a physical therapist.
  • Injections of cortisone (steroid shots).
  • Heat and stretching exercises (for shoulder pain).
  • Electrical nerve stimulation, or the application of electrical currents to the skin, might stimulate nerves and muscle fibers and improve muscle tone and strength. This might reduce pain.

To find relief, you need to figure out the source of your pain. Pay attention to when it occurs and in what part of your body. Note whether it seems to be caused by something or someone touching you. Report your symptoms to your doctor. Together, you can deter­mine the best treatment. The good news is, some stroke survivors with chronic pain have spontaneous remission: one day the pain just goes away!

Professionals Who Can Help

A general physician or doctor.

  • Neurologist – specializes in prevention, diagnosis and treatment of stroke and other diseases of the brain and spinal cord.
  • Physiatrist – specializes in rehabilitation following injuries, accidents or illness.
  • Physical therapist – figures out and treats problems with movement, balance and coordination.
  • Psychologist – specializes in the study of the mind and behavior.


Take These Steps

  • Speak honestly with your caregivers about your pain issues. They’ll be glad you did. Together you can often work out the best solution.
  • Focus on thoughts or activities that you enjoy. You can still be active, productive and have a good quality of life.
  • Don’t let pain keep you from being active. Not using your muscles can lead to muscle spasms and/or loss of muscle.
  • Try relaxation, meditation or hypnosis to manage your pain.
  • Depression is common among those who suffer from chronic pain. Seek help if you are depressed.
  • Join a stroke support group. Other survivors will be understanding, validate your issues and offer encouragement and ideas for pain relief.
  • Contact your local stroke association.
  • Ask you doctor about the best treatments for your symptoms.


Solutions to Try at Home

  • Avoid things that can cause pain, such as hot baths, tight or easily bunched clothing and pressure on the side of your body affected by the stroke.
  • Position or splint weakened or paralyzed arms or legs to reduce discomfort.
  • Use heat packs or exercises prescribed by your physical therapist.
  • While sitting or lying down, support your paralyzed arm on an armrest or pillow to relieve shoulder pain from the arm’s weight.
  • Support your weakened or paralyzed arm with a sling while walking to reduce shoulder pain.


 

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National Stroke Association’s mission is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all impacted by stroke.

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