Pain management after stroke Fact Sheet

Pain
management
after stroke
Fact Sheet
Call StrokeLine 1800 STROKE (787 653)
Summary
What is pain?
•Pain can be felt if there is real or
potential damage to body tissue.
It can also be felt if the nerve itself
has been damaged.
There are two main types of pain following
stroke.
•Pain experienced after a stroke can
include central post-stroke pain
(CPSP), headaches and shoulder
pain.
•Pain management may include
medications, psychological
treatments, stress management
and relaxation, keeping active,
eating healthy and physiotherapy
exercises.
•You may be referred to a specialist
pain team.
• If you have actual or potential damage to body
tissue you feel tissue injury pain (or nociceptive
pain). You may feel this if you have shoulder
subluxation or muscle contractures.
• Damaged nerves may send incorrect or extra
messages which cause you to feel nerve
injury pain (or neuropathic pain). One type of
neuropathic pain is called central pain. This is
when the area of your brain and spinal cord
that allows you to feel pain is injured. It can
cause you to feel constant pain in many areas
of your body. Central post-stroke pain is a type
of pain that occurs after stroke.
Pain may be described as ‘acute’ or ‘chronic’.
Acute pain lasts only for a short time (less than
three months) while the body part affected is
healing. It is usually easy to know what is causing
the pain (an injury). It generally improves with
treatment.
Chronic pain lasts for a longer period of time
(three months or more). It may continue even
though the body part has healed. There are many
factors that can contribute to chronic pain. It
often needs different treatment than acute pain.
Fact Sheet | Pain management after stroke
Pain management after stroke
What kinds of pain might I
feel after stroke?
Central post-stroke pain (CPSP)
CPSP is a type of central or neuropathic pain
which may feel like burning, stabbing, prickling or numbness on the skin on the side affected by
your stroke. Often this pain is made worse if you
are touched, move or place the affected area in
water. CPSP may start days, months or years
after your stroke. CPSP is sometimes called
‘thalamic pain syndrome’ because of the area of
the brain which the stroke may have damaged.
Headache
These are more common after haemorrhagic
stroke than ischaemic stroke. It is not always
known what causes headaches, but it can
sometimes be a side affect of medications.
Shoulder pain and other
musculoskeletal problems
These are common after stroke and it is not
always clear why. Pain will usually be on the side
of your body affected by the stroke. Shoulder
pain and other musculoskeletal pain is often
caused by:
• High tone (also called hypertonia or spasticity)
means having a high amount of tension in your
muscles. If you have high tone your muscles
will be very stiff or tight.
• Contracture means that muscles or joints
become shorter or less flexible. This may
happen if there is muscle weakness or high
muscle tone that limits the movement in your
arm or leg.
• Shoulder subluxation caused by weak muscles
allowing the top of your arm to slip out of the
shoulder socket slightly.
• Some people will feel shoulder pain and other
musculoskeletal pain without any of these
causes. See the Upper limb movement after
stroke fact sheet for more information.
What can I do about this
pain?
Your doctor will work with you to identify the
cause of your pain. They will ask you questions
about where your pain is and things that make it
better or worse. They may ask you to rate your
pain on a scale or questionnaire, or keep a diary
of the pain. The strategies that your doctor may
recommend to manage your pain include:
Pharmacological Management
This is using medication to improve your pain.
See the Medication after stroke fact sheet for
more information.
Your doctor is the best person to determine if
medication may help with your pain. Sometimes
medications prescribed by your doctor will
interact with other medications including overthe-counter medications or herbal remedies.
It is important that you talk to your doctor
or pharmacist about all the medications you
are taking. This includes natural remedies or
vitamin supplements. There are many types of
medications that may help depending on the
type of pain you feel. These might include:
• Non-steroidal anti-inflammatories and
paracetamol. To help to reduce inflammation.
• Opioids. These act like hormones your body
produces to reduce pain.
• Anti-depressants. These change the amount of
specific chemicals in your brain and ‘dampen
down’ the pain messages and may be useful
for CPSP.
• Anti-epileptic medications. To reduce excess
electrical activity in the brain which can be
associated with neuropathic pain and may be
useful for CPSP.
Non-Pharmacological Management
Using techniques other than medication to
improve your pain. These might include:
• Psychological techniques. Aim to change
thoughts, beliefs and behaviours related to
pain. This might include cognitive behavioural
therapy (CBT), hypnosis, attention-diversion
strategies, biofeedback or stress management
and relaxation techniques.
• Transcutaneous electrical nerve stimulation
(TENS). This may be useful for CPSP and
shoulder pain.
• Exercise. Your therapist may recommend
exercises, positions and supportive devices to
help support a painful shoulder or arm.
• Keeping active. This is important. Being active
releases endorphins in your body. Endorphins
are naturally occurring pain reducing
substances in the body. Try to exercise or be
active within your own limits, and talk to your
general practitioner or physiotherapist before
beginning a new exercise program.
• Eating a healthy diet. Also limiting the use of tobacco, alcohol and caffeine.
• Specialist pain management team. If the pain
doesn’t resolve within a few weeks, your
doctor may refer you to a specialist pain team.
This is a group of health professionals who
specialise in assessing and managing complex
or chronic pain problems.
Your doctor will work with
you to identify the cause of
your pain. They will ask you
questions about where your
pain is and things that make
it better or worse
Fact Sheet | Pain management after stroke
Where can I get help?
Talk to your doctor or health professional about
any pain that you have.
There are support groups and health services to
help you cope with chronic pain.
Talk to your doctor to get local contact details.
The following websites provide usual
information about pain and pain
management. Go to:
www.hnehealth.nsw.gov.au/pain
www.synapse.org.au/Medical/handling-painand-acquired-or-traumaticbrain-injury-factsheet
www.synapse.org.au/Medical/headachesand-acquired-or-traumatic-brain-injury-factsheet
www.painaustralia.org.au
National Stroke Foundation
National Office
Level 7, 461 Bourke Street
Melbourne VIC 3000
Phone: +61 3 9670 1000
Email: admin@strokefoundation.com.au
www.strokefoundation.com.au
We have offices in Brisbane, Sydney, Hobart and Perth.
Call StrokeLine 1800 STROKE (787 653)
Proudly supported by Allergan Australia P/L.
For a complete list of fact sheets, visit our online
library at www.strokefoundation.com.au
© National Stroke Foundation. FS13_May2012
Printed on 100% post-consumer recycled paper.
Fact Sheet | Pain management after stroke