- Pain is a common but poorly recognised consequence of stroke
- 30-40% of patients are left with chronic pain from various aetiologies
- Central post-stroke pain accounts for a third of post-stroke pain
- It develops in the 3-6 months after stroke
- More common in younger patients, those with thalamic strokes and those with right hemisphere strokes
- Arises due to lesions of the:
- Thalamus (Dejerine-Roussy Syndrome)
- Spinothalamic tracts
- Brain stem
- Cortex
- Tends to occur in an area with altered sensation
- Gradual onset of symptoms, which is usually associated with improved subjective sensory loss and the appearance of dysaesthesia
- Constant, severe pain with superimposed lancinating pain
- Associated allodynia (70%), hyperalgesia and paraesthesia
- Complex regional pain syndrome
- Dysaesthesia and allodynia of an area affected by the central lesion e.g. face, hands and feet and sometimes upper parts of limbs
- Post-stroke shoulder pain
- Arises in up to 20% of patients within two weeks of stroke
- Occurs due to loss of muscle strength and consequent subluxation of the shoulder joint ± impingement of the brachial plexus
- Can impair rehabilitation, reduce functional capacity and increase disability
- Spasticity-related pain due to hypertonus (25% of patients)
- Headaches
- Symptoms akin to tension-type or vascular type headache
- More common in those with pre-existing headaches
- Management of post-stroke pain is difficult due to:
- Difficulties in assessment due to expressive dysphasia
- Difficulties in rehabilitation due to coalescing depression, anxiety and sleep disorders
- Biological (pharmacotherapy)
- Antiepileptics e.g. gabapentinoids, lamotrigine
- SNRIs e.g. duloxetine
- TCAs
- Neurostimulation has been used in resistant cases
- Psychological e.g. neuropsychology
- Social e.g. physiotherapy and rehabilitation