Stroke's Burning Question: Why Do I Feel This?

A stroke is a serious, life-changing injury that can result in a wide variety of secondary effects, including nerve pain or neuropathy. This type of chronic pain condition can be challenging for survivors, but there are ways to treat it. Central post-stroke pain (CPSP), a less common type of pain, is caused by damage to the brain from a stroke and can result in a burning sensation. It can also cause tingling or stabbing pains. While burning sensations are not a primary red flag for stroke, they can be a symptom, and it is important to seek medical attention if you experience them.

Central post-stroke pain (CPSP) is a less common type of pain caused by damage to the brain from a stroke

The symptoms of CPSP include a burning sensation, pins-and-needles sensation, intense stabbing or searing pain, and increased sensitivity to tactile stimulation. For example, a gentle breeze on the skin can feel like razor blades or intense burning. This type of pain can be constant or come and go, and it can last a long time after a stroke.

The treatment for CPSP includes pharmacologic and non-pharmacologic methods. Pharmacologic treatments include anticonvulsants, antidepressants, and corticosteroids. Non-pharmacologic treatments include physical therapy exercises, electroacupuncture, and deep-brain stimulation.

It is important to talk to a doctor if you are experiencing any symptoms of CPSP. They can prescribe medications to help manage the pain and refer you to special pain management programs that can teach you body and mind exercises to cope with the pain.

CPSP affects around 1-8% of stroke survivors and can develop months or even years after a stroke

Central post-stroke pain (CPSP), also known as central neuropathy, is a less common type of pain that affects around 1-8% of stroke survivors. It is caused by damage to the brain from a stroke and can develop months or even years after a stroke.

CPSP is characterised by a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. It can also increase sensitivity to tactile stimulation, where a gentle breeze across the skin can feel like razor blades or intense burning. This type of pain is chronic and can be present even if the survivor has diminished sensation in the affected areas of the body.

The burning sensation associated with CPSP is a result of central neuropathy, which occurs when the central nervous system, including the brain or spinal cord, is injured. In the case of a stroke, this nerve pain is the result of tissue damage within the brain. While it was once thought that CPSP was solely due to injury to the thalamus, an area deep within the brain, it is now known that damage to other areas of the brain can also cause this condition.

The delayed onset of CPSP can lead to misdiagnosis, as survivors of stroke can develop central neuropathy as late as 6 years following their initial injury. It is critical to obtain an accurate diagnosis and distinguish CPSP from localized pain, as treatment for localized pain is ineffective for central neuropathy.

Treatment for CPSP includes pharmacologic and non-pharmacologic approaches. Pharmacologic treatments may include anticonvulsants, antidepressants, and corticosteroids. Non-pharmacologic approaches can involve physical therapy exercises, electroacupuncture, and repetitive transcranial magnetic stimulation.

CPSP can cause a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain

Central post-stroke pain (CPSP) is a less common type of pain caused by damage to the brain from a stroke. CPSP can cause a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. This type of pain affects around 1-8% of stroke survivors and can develop months or even years after a stroke. It is often chronic and can be present even if the survivor has diminished sensation in the affected areas of the body.

CPSP is characterised by damage to the central nervous system, which includes the brain and spinal cord. It is typically treated with more aggressive treatment methods, including pharmacologic and non-pharmacologic treatments. Treatment options may include anticonvulsants, antidepressants, corticosteroids, physical therapy, electroacupuncture, and deep-brain stimulation.

It is important to note that peripheral neuropathy, another type of nerve pain that can occur after a stroke, is caused by damage to nerves outside of the brain and spinal cord. This type of nerve pain is typically localised to one area of the body and is treated differently from CPSP.

If you are experiencing any type of nerve pain or other unusual symptoms after a stroke, it is important to consult with your healthcare team to determine the best course of treatment.

CPSP can increase sensitivity to tactile stimulation, e.g. a gentle breeze across the skin can feel like razor blades or intense burning

Central post-stroke pain (CPSP) is a less common type of pain that affects around 1-8% of stroke survivors. It is caused by damage to the brain from a stroke and can present as a chronic burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. This type of pain can be constant or come and go, and it can last a very long time after a stroke.

CPSP can increase sensitivity to tactile stimulation, which means that a gentle breeze across the skin can feel like razor blades or intense burning. This heightened sensitivity to touch can make everyday activities difficult and painful. The pain is typically felt in the same areas of the body that were affected by the stroke.

The burning sensation associated with CPSP is a result of central neuropathy, which occurs when the central nervous system, including the brain or spinal cord, is injured. In the case of a stroke, this nerve pain is caused by tissue damage within the brain. While it was previously thought that CPSP was solely due to injury to the thalamus, it is now known that damage to other areas of the brain can also cause this condition.

Diagnosing CPSP can be challenging because the pain may develop months or even years after a stroke. It is important for stroke survivors to monitor their recovery and keep records of any new symptoms, as this information can help doctors make an accurate diagnosis.

Treating CPSP typically involves a combination of pharmacologic and non-pharmacologic treatments. Medications such as anticonvulsants, antidepressants, and corticosteroids may be prescribed to help manage the pain. Non-pharmacologic approaches include physical therapy exercises, electroacupuncture, and repetitive transcranial magnetic stimulation.

CPSP is treated with medications, exercise, and modalities like repetitive transcranial magnetic stimulation

Central post-stroke pain (CPSP) is a rare neurological disorder that affects 1-8% of stroke survivors. It is characterised by a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. CPSP is treated with a combination of medications, exercise, and modalities like repetitive transcranial magnetic stimulation (rTMS).

Medications

Pharmacologic management of CPSP involves the use of various antidepressants, anticonvulsants, opioids, N-methyl-D-aspartate (NMDA) antagonists, antiarrhythmics, and gamma-aminobutyric acid (GABA) agonists. Antidepressants such as tricyclic antidepressants (e.g. amitriptyline) and selective serotonin reuptake inhibitors (SSRIs) are often used as first-line treatments. Anticonvulsants like gabapentin and pregabalin can also be used as first or second-line treatments. Opioids are generally not recommended due to their potential for dependence, but tramadol, which has serotonin/norepinephrine reuptake inhibitor action, may be an exception.

Exercise

Physical therapy exercises can help improve mobility and reduce nerve pain symptoms. For example, a study found that physical therapy focusing on motor training and mirror therapy reduced CPSP symptoms for a survivor of thalamic stroke. This is due to the brain's neuroplasticity, or its ability to create and rewire neural pathways.

Repetitive Transcranial Magnetic Stimulation

RTMS is a non-invasive, non-drug therapy that is safer than invasive treatments and more easily accepted by patients. It involves delivering electromagnetic pulses to specific areas of the cerebrum, which can help to relieve pain by altering cortical excitability, modulating the release of neurotransmitters, and affecting the structural and functional connectivity of brain regions involved in pain processing and modulation. High-frequency rTMS has been found to provide better pain relief than low-frequency stimulation, and stimulation of the premotor cortex (M1) site has been shown to have a more significant analgesic effect than other sites.

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