Stroke Symptoms And Pain Pumps: What's The Link?

A stroke occurs when a blockage or a burst artery prevents blood from reaching the brain, leading to brain tissue damage. While the symptoms of a stroke vary among individuals, they typically include numbness, weakness, and difficulty talking. A stroke is often not associated with pain, and many people who have a stroke do not feel any pain. However, post-stroke pain is a common symptom, and about 10% of people who experience a stroke develop severe pain known as post-stroke pain, central pain, or thalamic pain. This pain can manifest in various ways, including burning, aching, and prickling sensations, and it can affect different parts of the body, including the face, arm, leg, or trunk. The pain usually worsens over time and can be aggravated by temperature changes or movement. It is important to seek medical attention immediately if you experience any symptoms of a stroke, as fast action is essential for minimizing damage and improving recovery outcomes.

Post-stroke pain can be central or peripheral

Peripheral pain after a stroke can be caused by muscle and joint pain, such as spasticity and shoulder pain, headaches, and complex regional pain syndrome (CRPS). Spasticity is an involuntary, often painful, contraction of muscle groups, which can lead to the development of contractures—a shortening of the muscle body and tendon that can result in irreversible non-functionality. Complex regional pain syndrome (CRPS) is a condition characterised by burning pain, increased sensitivity to tactile stimulation, and vasomotor changes, including edema and changes in skin temperature and colour.

Central post-stroke pain (CPSP) is caused by the brain, not the body

Central post-stroke pain (CPSP) is a condition that affects about 10% of people who experience a stroke. It is caused by damage to the brain's pain-processing pathways, specifically the tracts responsible for transmitting pain signals throughout the central nervous system. This damage can occur in various parts of the brain, including the thalamus, spinothalamic tract, trigeminothalamic pathway, and lemniscal pathway.

CPSP typically presents as a mix of painful sensations, including hot and cold feelings, burning, tingling, numbness, sharp stabbing, and underlying aching pain. It can affect different parts of the body, such as the face, arm, leg, or even an entire half of the body, and is usually felt on the side affected by the stroke. The pain can be constant or intermittent and may be aggravated by touch, movement, or changes in temperature.

The onset of CPSP can vary, sometimes occurring days or years after a stroke, and it can be challenging to treat. While medications such as antidepressants and anti-seizure drugs may help manage the pain, they are often ineffective, and surgical treatments, such as deep brain stimulation, may be required for significant pain relief.

In summary, central post-stroke pain is a complex condition caused by injuries to specific areas of the brain that process and transmit pain signals. It can have a significant impact on a person's life, affecting their movement, emotional state, and overall quality of life.

CPSP can be induced or spontaneous

Central post-stroke pain (CPSP) is a severe, chronic pain disorder that affects around 1-12% of people who have had a stroke. It is caused by damage to the brain's pain-processing pathways, resulting in abnormal sensations such as burning, prickling, and numbness. CPSP can be induced or spontaneous, and it can develop immediately after a stroke or up to years later.

CPSP is characterised by either spontaneous or evoked unpleasant feelings, such as allodynia (pain from stimuli that do not normally cause pain), hyperalgesia (increased sensitivity to pain), and dysesthesia (unpleasant abnormal sensations). These abnormal sensations are caused by insults to the central nervous system, which induce neurochemical reactions, cytotoxicity, and inflammation at the cellular level. This leads to maladaptive neuroplasticity, resulting in the abnormal sensations of CPSP.

Spontaneous pain in CPSP is linked to hyperexcitability or spontaneous discharges in deafferented neurons of the thalamus and cortex. CPSP is also associated with increased neuronal excitability, which is attributed to a loss of inhibition and excessive neuroinflammation. Abnormal hyperactivity in the pain network can be explained by the "disinhibition theory", which states that the central nervous system is controlled by a delicate balance between excitation and inhibition.

The onset and character of CPSP are highly variable, and it can be challenging to establish a definitive diagnosis due to variable clinical pictures and the lack of clear diagnostic criteria. However, CPSP significantly impacts the quality of life of those affected, and various treatments are available, including medications and brain stimulation therapies.

CPSP can be treated with antidepressants and anti-seizure medications

Central post-stroke pain (CPSP) is a frequent complication of strokes, affecting up to one in five survivors. It is caused by the brain rather than the body and can manifest as a range of sensations, including hot, cold, burning, tingling, prickling, stabbing, or numbness on the skin. The pain usually occurs on the side of the body affected by the stroke and can be aggravated by touch, movement, or changes in temperature.

While there is no one-size-fits-all solution for treating CPSP, medical professionals may prescribe certain medications to help manage the pain. Antidepressants and anti-seizure medications are two types of drugs that have been found effective in alleviating CPSP.

Antidepressants work by altering the brain's chemistry and have been shown to be beneficial in CPSP treatment. The tricyclic antidepressant amitriptyline (Elavil) is one such medication that has proven efficacy in addressing constant pain associated with CPSP. It is important to note that while amitriptyline can help with constant pain, it may not be as effective for intermittent stabbing pain.

Anti-seizure medications, also known as anti-epilepsy drugs, can be beneficial in CPSP management. Gabapentin (Neurontin) and pregabalin are two such medications that can help reduce brain activity that triggers pain messages. These drugs work by changing the chemicals in the brain and have been found to be more effective than ordinary painkillers like paracetamol or ibuprofen in treating CPSP.

It is important to note that the choice of medication depends on various factors, including the patient's medical history, the severity of the stroke, and the specific symptoms they are experiencing. Additionally, a combination of medications may be prescribed to achieve the best results.

In addition to pharmacological treatments, non-pharmacological approaches such as cognitive-behavioural therapy, attention diversion strategies, stress management, and relaxation techniques can also be beneficial in managing CPSP. Seeking support from mental health professionals who have experience treating patients with chronic pain can be an essential part of the recovery process.

Shoulder pain is common after a stroke

Shoulder pain is a common issue for people recovering from a stroke, affecting between 16% and 72% of patients. It usually occurs on the side of the body affected by the stroke. The shoulder joint is a 'ball and socket' joint, with the rounded shape at the end of the upper arm fitting into a hollow space in the shoulder blade. The arm bone is held in place by muscles and ligaments.

After a stroke, the arm muscles can become very weak, stiff, or paralysed, and the effect of gravity puts a strain on the ligaments and the capsule surrounding the joint. This can cause the shoulder joint to become inflamed, stretched, and damaged, resulting in a condition called frozen shoulder or capsulitis.

Another common cause of shoulder pain after a stroke is subluxation, which is a partial dislocation of the shoulder joint. This happens when the muscles that normally hold the joint in place are weakened, and the weight of the arm pulls and stretches the soft tissues. Shoulder subluxation can often be managed by positioning the arm correctly, especially when sitting, as this is when subluxation is usually more noticeable.

To prevent and treat shoulder pain, proper shoulder support is essential. Foam supports, shoulder taping or orthotic supports, and slings can be used to reduce subluxation and provide support. It is important to work with a physical therapist to choose the most appropriate style of support and to learn how to use it correctly.

In addition to physical treatments, painkillers such as paracetamol may be prescribed to manage shoulder pain. If pain and inflammation persist, steroid injections may be used.

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