Post Stroke

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.

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.

What treatments are available?
Identifying the type or source of the pain determines the recommended treatment.
For joint pain:

  • 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. Traditional physical therapy is offered through Somersworth Physical Therapy and a more holistic approach is offered through Total Body Therapy.
  • 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.

 

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