Understanding Post-Stroke Burning Sensation: A Medical Mystery

A burning sensation after a stroke is a less common type of pain called central post-stroke pain (CPSP). CPSP is caused by damage to the brain from a stroke. It affects around 1-8% of stroke survivors and can develop months or even years after the stroke. The pain can be constant or intermittent, and it can last a long time. CPSP is often treated with aggressive treatment methods, including pharmacologic and non-pharmacologic treatments.

Central post-stroke pain (CPSP)

The pain associated with CPSP can be intense and is described as a burning sensation, pins and needles, or sharp stabbing. It can be constant or intermittent and can last for months or years after a stroke. The pain can be triggered by anything that touches the skin, changes in the weather, or emotional distress.

Diagnosing CPSP is challenging as it requires ruling out other post-stroke conditions. Treatment options include pharmacological and non-pharmacological interventions, such as medication, physical therapy, acupuncture, and neurosurgery.

Peripheral neuropathy

There are four types of peripheral neuropathy:

• Sensory neuropathy: damage to the nerves that carry sensations like touch, temperature, and pain. Symptoms include a prickling or tingling sensation in the affected body part, pins and needles, a burning or sharp pain (usually in the feet), numbness, and loss of balance or coordination.
• Motor neuropathy: damage to the nerves that control movement. Symptoms include twitching and muscle cramps, muscle weakness or paralysis, thinning of muscles, and foot drop.
• Autonomic neuropathy: damage to the nerves that control involuntary bodily processes, such as digestion, bladder function, and control of blood pressure. Symptoms include constipation or diarrhea, feeling sick, low blood pressure, rapid heartbeat, excessive sweating or lack of sweating, and problems with sexual function.
• Mononeuropathy: damage to a single nerve outside of the central nervous system. Symptoms depend on which specific nerve is affected and can include pain, weakness, or altered sensation in the fingers, feet, or shins; double vision or other problems with focusing the eyes; and weakness of one side of the face. The most common type of mononeuropathy is carpal tunnel syndrome.

The symptoms of peripheral neuropathy can vary depending on the type and can develop quickly or slowly. In many cases, an individual with peripheral neuropathy may have more than one type at the same time. A combination of sensory and motor neuropathy is particularly common.

Diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. Peripheral neuropathy becomes more likely the longer an individual has had diabetes, especially if blood sugar is poorly controlled. Other causes of peripheral neuropathy include vitamin B12 deficiency, alcohol consumption, malnutrition, chemotherapy, physical injury to the nerves, infections, chronic kidney disease, and liver disease.

Treatment for peripheral neuropathy typically involves pain medication, anticonvulsants, topical pain relievers, and antidepressants.

Central neuropathy

Treatment for central neuropathy can consist of medications, exercise, and modalities like repetitive transcranial magnetic stimulation. If these treatments are not effective at reducing symptoms, more intense or invasive treatments like deep brain stimulation may be considered.

Treatment options for nerve pain after stroke

Nerve pain after a stroke, or neuropathy, can be tricky to diagnose and treat. It's important to understand the different types of neuropathy and their causes. Peripheral neuropathy, for example, is a co-occurring condition caused by localized nerve damage outside of the brain and spinal cord, often affecting the hands and feet. On the other hand, central neuropathy stems from damage to the central nervous system, including the brain, and can result in debilitating pain.

Treatment Options for Peripheral Neuropathy:

• Pain medication: Over-the-counter medication may help with mild symptoms, while prescription pain medication may be necessary for more severe cases.
• Anticonvulsants: Gabapentin and pregabalin, typically used to treat seizures, can also relieve nerve pain. However, they may cause side effects such as dizziness and lack of coordination.
• Topical pain relievers: Lidocaine patches or pain relief creams applied to the skin can numb the area and provide temporary relief.
• Antidepressants: Certain tricyclic antidepressants have been found to help alleviate neuropathic pain.

Treatment Options for Central Neuropathy:

• Anticonvulsants: Medications used to treat seizures may help reduce excitability in nerve cells that send pain signals.
• Antidepressants: Amitriptyline is the first-line drug for central neuropathy. However, high doses may not be well-tolerated and can cause intense side effects.
• Corticosteroids: Prednisone and other corticosteroids may provide pain relief for central post-stroke pain and are even more effective when combined with anticonvulsants.
• Exercise: Physical therapy exercises can not only improve mobility but also reduce nerve pain symptoms due to the brain's neuroplasticity.
• Electroacupuncture: Electrical stimulation through acupuncture needles inserted into the body has been found to help relieve central post-stroke pain.
• Deep brain stimulation: This invasive treatment involves placing small electrodes deep within the brain to stimulate the central nervous system.
• Repetitive transcranial magnetic stimulation: This cutting-edge treatment may be beneficial when the source of neuropathic pain is damage to the thalamus.

Sensory re-education

A stroke is a serious, life-changing injury that can result in a wide variety of secondary effects, including nerve pain and neuropathy. Central neuropathy, also known as central post-stroke pain (CPSP), is caused by damage to the central nervous system, including the brain. This type of nerve pain is characterised by a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. It affects around 1-8% of stroke survivors and can develop months or even years after the initial injury.

• Tabletop Touch Therapy: Place a variety of objects with different textures, such as soft scarves, rough sandpaper, fluffy cotton balls, rough Velcro, and cold cutlery, on a table in front of you. Without looking, pick up the objects and try to distinguish between the different textures. Bury some textured objects in a bowl of uncooked rice and try to find them without looking.
• Texture Recognition: Have someone place different objects in your hand with your eyes open. Feel the textures and practice naming them, such as rough, smooth, or bumpy. Once you've identified all the objects, perform the exercise again with your eyes closed. Focus on feeling each object to imprint the connection in your mind.
• Temperature Differentiation: This exercise is particularly beneficial for stroke survivors who have trouble distinguishing between heat and cold. Soak a cloth in cold water and another in warm water. Have someone place the cold cloth on your arm, then switch to the warm cloth after 30 seconds. Try to sense the difference in temperature. Close your eyes and try to identify whether you are feeling heat or cold.
• Touch Localisation: Close your eyes and have someone place their hand on your arm. Point to the area where you think they touched. If you don't point to the correct area, have them move your hand to the correct location and then open your eyes. Repeat this exercise at least 10 times. As you improve, vary the exercise by having your assistant touch you with different textured objects.
• Using a TENS Machine: The tingling sensation provided by a TENS machine can help stimulate sensation in your arm.

It is important to work closely with an occupational or physical therapist to create a personalised rehab plan that will optimise your recovery. Additionally, be mindful of the risks associated with decreased sensation and take proactive measures to reduce these risks, such as regular skin checks and avoiding remaining in one position for too long.

Frequently asked questions