MANAGING PAIN AFTER STROKE
What you need to know
After a stroke you may experience injury pain, neuropathic pain (a shooting or burning pain. It can go away on its own but is often chronic) and headaches. The team treating you will help to identify the cause of pain. This pain can be treated with medication and a range of different treatments.
Injury pain
If you have damaged body tissue, the pain you feel is related to this. Could be cause by:
- Contracture – muscles, tendons or other tissues gets shorter, forcing a joint to stay in one position. This normally causes a lack of movement and/or use or the limb
- High tone – muscles are tight and stiff or rigid
- Using or moving joints wrongly adds a lot of strain on the muscles and joints leading to pain
- Pain is usually be on the stroke-affected part but it can be experienced on the good side due to over use
Neuropathic pain
This is caused by damage to the brain’s pain-processing pathways. Only about 10% of the pain suffered by stroke survivors is neuropathic. It is also called central post stroke pain (CPSP) or nerve pain. This type of pain occurs more often when sensation is reduced after a stroke. The brain is used to receiving normal sensory inputs, and when it doesn’t, painful sensations can be generated.
CPSP may feel like burning, stabbing, prickling or numbness on the skin. It mostly occurs on the stroke-affected side of the body. Often this pain is made worse if you are touched or moved, or the affected area is placed in water. CPSP may start days, months or years after a stroke.
Headaches
Headaches are more common after a haemorrhagic stroke. Irritation or pressure on the lining of the brain can cause headaches.
It can also occur after an ischaemic stroke and can be caused by clots or tears in the blood vessel.
Headaches can also be a side effect of medicines, and a dull, generalised headache can sometimes be part of post-stroke fatigue
Discuss headaches with your doctor especially, if they worsen.
Duration of pain
Acute – pain lasts only for a short time, usually while the affected part of the body is healing. Generally, improves with treatment.
Chronic – pain lasts for a longer period, usually three months or more. It may continue even though the affected part has healed.
Treatment and recovery
Once the cause of pain is identified treatments recommended include :
Medication – for injury pain, non-steroidal anti-inflammatories and paracetamol may be prescribed. Local anaesthetic or steroid injections are sometimes used for shoulder pain. Opioids, which act like the chemicals your body produces to reduce pain, may also be prescribed for injury pain.
Ordinary painkillers are not usually helpful in relieving neuropathic pain. Some anti-epilepsy or anti-depressant medications can be effective in reducing the production of pain messages in the brain.
Psychological therapies – can help change thoughts, beliefs and behaviours related to pain. This includes:
- Cognitive behavioural therapy
- Hypnosis
- Attention-diversion strategies
- Biofeedback
- Stress management and relaxation techniques
Treating depression may also reduce pain. Ensure good sleep as lack of it can worsen pain.
Electrical stimulation – to activate nerves. May be useful for shoulder dislocation (subluxation) pain.
Exercise and equipment – exercises, positions and supportive devices can help support a painful shoulder or arm. Therapists can also recommend correct movement patterns.
Keeping active – releases endorphins in your body that help reduce pain naturally. Try to exercise or be active within your own limits. Talk to your doctor or physiotherapist before beginning a new exercise program.
Specialist pain management clinic – can teach techniques to cope with chronic pain. Quality of life and levels of activity can be restored, even if the pain itself is not completely relieved. Your doctor can arrange access to a pain clinic if required.