Demystifying post-stroke pain: from etiology to treatment

PM R, 2017 · DOI: 10.1016/j.pmrj.2016.05.015 · Published: January 1, 2017

Neurology Pain Management Neurorehabilitation

Simple Explanation

Pain after stroke is a common symptom that is poorly understood by many practitioners. It can be easily overlooked due to its variable characteristics, concurrent comorbid medical issues, or impairments in cognition or communication. The review aims to present and clarify the major pain syndromes that affect patients who have suffered from stroke in order to aid in their diagnosis and treatment. Post-stroke pain is often refractory or responds incompletely to medication and other treatments and is thus challenging to control for many patients.

Study Duration

Not specified

Participants

Review article, participants not applicable

Evidence Level

Not specified

Key Findings

1
Central post-stroke pain (CPSP) is the most frequent diagnosis among patients with ischemic strokes who experience chronic post-stroke pain, followed by peripheral neuropathic pain, pain due to spasticity, and joint subluxation.
2
Lesions in the posterolateratal and inferior parts of the VPL were most associated with CPSP.
3
Mirror therapy can be effective in post-stroke CRPS, with studies showing significant decreases in Visual Analog Scale scoring and improvements in motor function.

Research Summary

Post-stroke pain is a complicated phenomenon encompassing both nociceptive and neuropathic pain etiologies. It is comprised by a variety of disorders, of which the most common include central post-stroke pain, complex regional pain syndrome, pain due to spasticity, and hemiplegic shoulder pain. The management and treatment of these syndromes include pharmacological, orthotic, biomechanical, electrophysiological and surgical therapies.

Practical Implications

Improved Diagnosis

A better understanding of the basis for development along with current and future treatment options for pain syndromes can aid in early diagnosis.

Targeted Therapy

Early diagnosis and therapy can improve outcomes for patients experiencing pain syndromes that impair stroke recovery.

Multimodal Treatment

Optimal treatment will often require a combination of therapy modalities.

Study Limitations

1
Limited presence in current discussions of stroke management.
2
Pain syndromes after stroke are in some ways unique to each patient and are often insufficiently managed.
3
Pharmacologic clinical trials in post-stroke CRPS seem to be greatly lacking

Your Feedback

Was this summary helpful?

Back to Neurology