Coping with Pain

Stroke survivors often experience pain after their strokes. This spans a spectrum from irritating headaches to crippling joint pain. Whatever the level of pain, it compromises quality of life for patients and caregivers.

Shoulder pain is one of the most common pain issues following a stroke, and there are two types:

Limited range of motion - the resulting immobility can cause “frozen shoulder,” which is really scar tissue that forms in the joint.

Subluxation - this basically means the arm falls out of its socket because the shoulder muscle is no longer strong enough to hold it.

The best way to treat shoulder pain is by using range-of motion-exercises with the therapist maintaining the correct anatomic position of the shoulder joint as much as possible. In addition to range-of-motion exercises, muscle block injections with anesthetic and the use of botox have proven quite successful at reducing pain.

Spasticity is abnormal tone that causes the muscle to constantly contract. Stretching the arm out to its full range of motion becomes extremely painful, the joints become stiff and adhesions develop. Medications that specifically address spasticity such as baclofen and botox injections are essential tools in pain management.

Immobility and muscle weakness can also cause pain for survivors. As a result of decreased activity, the muscles and joints become stiff, which restricts a patient’s movement either for walking or activities-of-daily-living (ADL) tasks.

Headaches are common in the months following a stroke, but they generally resolve themselves and are not a source of long-term, incapacitating pain.

Pain, of course, limits all aspects of life. The more severe the pain, the more impact there is on therapy participation, sleep and overall sense of well-being. Post-stroke pain is often a source of depression in survivors. People who experience pain for long periods of time must be closely monitored for signs of depression and stress syndromes, such as chronic fatigue because sleep is consistently interrupted.

Unfortunately, the old adage “no pain, no gain” often applies to treatment approaches that address post-stroke pain. Exercise can increase or decrease pain depending on the type of pain and type of exercise. Range-of-motion exercises should be done gently and with careful attention to avoid further trauma. Steroids and analgesics (painkillers) may help. But stretching is essential for maintenance and improvement of functioning. Positioning splints may also be required, which may be inconvenient and uncomfortable.

Of course, medication is the most common method for treating pain. The type of drug used depends on the type of stroke:

NSAIDs (non-steroidal anti-inflammatory drugs) – these should be avoided if the patient had a hemorrhagic stroke. The risk of bleeding is too high.

Aspirin combined with NSAIDs - ischemic stroke survivors should be careful about taking aspirin in conjunction with NSAIDs because of the increased risk of bleeding.

Narcotic painkillers - these can cause sedation. If the stroke has had an impact on the survivor’s cognitive ability, narcotics are likely to impair them further. There is also a risk of addiction.

The treatment of post-stroke pain is often complex. It is likely to involve a combination of drugs and physical and occupational therapy techniques as well as other medical interventions to address the various issues causing the pain. Unfortunately, the path to recovery can be slow and often requires a commitment to a maintenance exercise program to provide long-term benefit.