Each person feels pain differently. Damage to the brain due to stroke can sometimes make the sense of touch hurt. Pain can result from things like muscle tightness or weakness.

Pain can slow recovery from disease or injury and weaken the immune system. Also, it can lead to a lower quality of life, interfering with routine activities that make life rich and fulfilling, such as driving, shopping or hugging a child or grandchild. Most post-stroke pain can be treated.

Proper treatment requires a doctor’s involvement and possibly an integrative treatment approach, which could mean combining prescription medicines with complementary medicine, such as physical therapy or massage.

Pain can occur right after a stroke or weeks or even months after a stroke. Research indicates that as many as 74 percent of stroke survivors face some form of pain. In some cases, pain is constant (chronic). In others, it comes and goes.

Types

Stroke survivors experience two general types of pain:

Local Pain

Local or “mechanical” pain often results from damage to muscle or other soft tissue and is usually felt in the joints. Pain in the shoulder is especially common among stroke survivors. One of the reasons for this is that the shoulder joint is particularly susceptible to injury. Shoulder pain is especially common for those with upper limb paralysis or spasticity.

Sometimes shoulder pain is caused by a fall or other injury. Shoulder pain after stroke is most likely to be a problem in cases of restricted range of motion or a high level of dependence due to low general health. Paralysis, spasticity, diabetes, cerebrovascular lesion and sensory abnormalities are other risk factors.

Central Pain

Central post-stroke pain (CPSP) is also known as thalamic syndrome or thalamic pain syndrome. CPSP is characterized by constant, moderate or severe pain caused by damage to the brain. After a stroke, the brain does not understand normal messages sent from the body in response to touch, warmth, cold and other stimuli. Instead, the brain registers even slight sensations in the skin as painful.

CPSP is not very common in stroke survivors, with the highest number of cases reported at about 8 percent. Pain associated with CPSP often begins more than a month after the stroke, and therefore may seem to be unrelated. There is little information available about risk factors for CPSP and it is difficult to predict whether stroke survivors will be affected by it.

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Symptoms

The symptoms of pain in stroke survivors can vary. This is because there are many different causes of pain. Here is a list of the possible effects of post-stroke pain:

• Constant (chronic)
• Comes and goes
• Felt on part or all of the side of your body affected by the stroke
• Felt on the face, arm, leg or torso (trunk)
• Aching, burning, sharp, stabbing or itching

Stroke survivors with central pain may:

• 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.
• Stop using body parts that constantly feel pain.
• Allow muscles to weaken.
• Misuse drugs, suffer from depression and increase dependency on family members.

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Treatment

Some stroke survivors are hesitant to discuss pain with their doctor because they fear appearing weak.

• Experts recommend that patients keep a pain diary to record where pain originates and how often the pain is felt.
• Note whether it seems to be caused by something or someone touching you.
• Patient comfort guides can help assess pain.

These tools may make it easier to discuss details with your doctor. With your doctor’s help, the best treatment options, such as prescription medicines or physical therapy, can be determined.

Prescription medication

Traditionally, over-the-counter and prescription medicines to control chronic pain have not been very successful within the stroke survivor population. There are some prescription medicines approved by the Federal Drug Administration (FDA) for mechanical pain, but no medicines are currently approved for central pain.

The following is a list of common types of medication that can be used to treat post-stroke pain:

• Analgesic pain killers
• Anticonvulsants
• Antidepressants
• Anti-spasticity muscle relaxants
• Muscle relaxants
• Non-steroidal anti-inflammatory drugs (NSAIDs)

Other treatments

• 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, may stimulate nerves and muscle fibers and improve muscle tone and strength to reduce pain

Healthcare 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 physical medicine and 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

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Management

Pain treatments can significantly improve the severity of the pain, but for people with chronic pain, the symptoms will never completely go away. Here are some tips and management solutions you can practice at home.

At-home pain solutions

• 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 simple 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.
• Use a shoulder support while walking to reduce shoulder pain.

Other tips for dealing with pain issues

• Try relaxation, meditation or hypnosis.
• Remain active, because not using muscles can lead to muscle spasms or loss of muscle.
• Depression is common among those who suffer from chronic pain. Seek help through your doctor or caregiver if you are depressed.
• Speak honestly with caregivers about pain issues.

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More Resources

Brochures
& Publications

Fact
Sheets

Online
Education

• StrokeSmart™: Pain Doesn't Have to Be Part of Stroke Recovery

• Dealing With Pain

• iHOPE: Pain

Other resources for information:

• American Chronic Pain Association: www.theacpa.org
• In the Face of Pain: www.inthefaceofpain.com
• National Family Caregivers Association: www.nfcacares.org

• Partners Against Pain: www.partnersagainstpain.com
• Stanford Hospital and Clinics Post-stroke Pain:stanfordhospital.org/clinicsmedServices/COE/neuro/chronicPain/pain/strokePain.html