PainCare - the leading Pain Management specialists in NH

What is post-stroke pain?

Pain that follows a stroke is termed post-stroke pain. Stroke (a cerebrovascular accident, or CVA) is the leading cause of long-term disability in adults. Most strokes do not cause pain, only numbness. However, sometimes this numbness is accompanied by a deep burning, pins and needles sensation and often by muscle contraction. 

What causes stroke and the resulting post-stroke pain?

A stroke is caused by the disruption of blood to the brain, usually by a clot in an artery or a ruptured blood vessel causing hemorrhage. Within minutes, lack of oxygen and nutrients to the brain causes cells to begin the dying process.

Because the brain is so complex and controls most bodily functions, the effects of a stroke can vary widely depending on which part of the brain was nourished by the clogged or ruptured artery. The severity of brain injury and subsequent symptoms depend upon the extent of cell damage and the area of the brain involved.

Stroke symptoms can be grouped into five categories:

• sensory disturbances (which includes pain)

• paralysis and mobility difficulties

• problems with speech

• thought and memory impairment

• emotional disturbances

Pain following a stroke may not be immediately evident. However, as weeks go by stroke survivors can experience chronic pain resulting from sensory nerve damage and also from intense muscle spasms/contractures. 

Is post-stroke pain preventable?

The overall best prevention for post-stroke pain is prevention of the stroke itself. According to the National Stroke Association, 80% of all strokes can be prevented. A focus on healthy lifestyle choices can reduce the likelihood of stroke, by eliminating risks such as obesity, high blood pressure, high cholesterol, uncontrolled diabetes, and smoking.

What treatments are available?

Some fortunate stroke survivors with chronic pain have experienced spontaneous remission; the pain disappears for no apparent reason. But for many, there is a long and arduous recovery period that entails re-learning the simple tasks of daily living such as eating, dressing, or even speaking as well as trying to accommodate the pain.

Identifying the type or source of the pain determines the recommended treatment.

• Movement, and sometimes heat, can be helpful in relieving discomfort.

• A physical therapist can teach mobility exercises for a paralyzed limb to you and a family member, minimalizing frozen joint syndrome and the pain related to it.

For neuropathic pain

• sympathetic nerve blocks,
• trial neuromodulation,
• and spinal cord stimulation can sometimes be helpful

For muscle spasticity:

• Physical therapy may be used to alleviate or prevent muscle spasticity, or atrophy. Passive movement of a paralyzed limb is essential to prevent painful "freezing" of the surrounding tissues and to allow easy movement if and when voluntary motor strength returns.

• Botox and simple local anesthetic injections may be used to block overactive nerve impulses and in turn inhibit excessive muscle contractions.

• Oral medication such as Baclofen may be prescribed to treat the general effects of spasticity.

• Complementary treatments such as nutritional therapy, acupuncture, and hypnosis may be useful.

• For severe refractory cases, implant technology such as pumps/catheters for intraspinal Baclofen and spinal cord/dorsal column stimulation can be considered.

When should I call PainCare?

Stroke survivors can receive substantial benefits from a pain management plan designed specifically for their needs by one of PainCare's specialists. Make an appointment at PainCare as soon as your condition has stabilized. Keep track of when and where your pain is felt, whether it is caused by someone or something touching you, and whether associated with muscle contraction. This information will be valuable in determining your best treatment options.