Pain after a stroke

Pain after a stroke is a fairly common situation. About 10% of stroke patients suffer from pain in various parts of the body. The intensity of pain after a stroke can range from moderate, causing some discomfort, to such severe pain that it can even prevent the body from recovering.

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Symptoms of pain after a stroke

Central post-stroke pain

Depending on where the pain after a stroke is localized, its symptoms vary. If the pain after a stroke is observed on one side of the body, most often on the limbs (arm pain after a stroke, leg pain after a stroke) - this is one of the typical symptoms that such a part of the brain as the thalamus was damaged during the stroke. Such pain after a stroke is considered central. Patients attribute different characteristics to it: burning, drilling pain, shooting pain. The intensity of thalamic pain can also vary, often "stroke patients" have to take medications to calm the pain.

However, central post-stroke pain occurs not only when the thalamus is affected: as practice shows, it also appears in situations where extrathalamic structures are affected. Many scientists agree that this type of pain is caused by post-stroke disorders in the functioning of almost any part of the human brain. Most often, this happens when the thalamus and caudal parts of the brain, as well as the parietal region of the cortex, are “affected.” And not every time the thalamus is damaged, pain syndrome is observed.

Pain after a stroke can be aggravated by various factors: movements, heat or cold, emotions. However, in some stroke patients, the same factors can actually weaken the pain after a stroke, especially heat. There are other neurological symptoms that cause central post-stroke pain: hyperesthesia, dysesthesia, numbness, changes in the sensation of heat, cold, touch, vibration. A special perception of temperature, tactile sensations, vibrations is a characteristic "alarm bell" in the diagnosis of central neuropathic pain after a stroke. Studies show the following results: more than 70% of patients complaining of central post-stroke pain do not feel the difference in temperature range from 0 to 50 °C. Allodynia, an unnatural painful sensitivity of the skin, is also observed with neuropathic pain. It is observed in 71% of stroke patients.

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Shoulder pain after stroke

Pain after a stroke can occur when any of the muscle groups are immobilized. Such pain occurs as a result of peripheral lesions.

A typical situation is pain in the shoulder after a stroke. It can appear when the brachial plexus is damaged, the muscles of the shoulder girdle are tense, and there is a subluxation in the shoulder joint. As for the latter, it occurs in the early post-stroke periods before the pain in the muscles after a stroke. Its cause is weakened muscles, their low tone, due to which the joint capsule gradually overstretches under the weight of the arm and subsequently leads to an incorrect position of the head of the humerus.

Muscle pain after stroke

Muscle pain after a stroke – muscle spasms – occur in stroke patients in the first period (a month or two) after a stroke and the associated cerebrovascular accident. These pains arise due to progressive muscle spasticity.

Classification of pain after stroke

Pain after a stroke can be:

• central post-stroke pain;
• affected joints of paretic limbs;
• pain after a stroke caused by painful spasms of the muscles of the paretic limbs.

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Treatment of pain after stroke

First, it is important to determine in which part of the body the pain after a stroke is concentrated, to understand where and when it occurs. Monitor the moment of its appearance: whether any of your actions or movements cause it, after which it appears. The best way out in a situation of pain after a stroke is to contact your doctor to select the appropriate methods for its elimination, medications, physiotherapy, etc. After all, everything is always individual and depends on a specific organism, and only a doctor can most accurately determine the causes. There are patients who are embarrassed to tell a doctor about their pain after a stroke, because they believe that it is weakness. This is fundamentally wrong, because such a position can provoke a slowdown in the body's recovery after a stroke, and sometimes even worsen the condition. Therefore, experts strongly recommend monitoring your feelings, even writing down in a diary where and how often pain occurs after a stroke.

In central post-stroke pain, when a specific area of the brain that controls subjective sensations is affected, conventional analgesics are ineffective because they act in a different way. When one half of the body hurts, for example, there is pain in the arm after a stroke or pain in the leg after a stroke, two groups of drugs are often used:

• antidepressants: amitriptyline, cymbalta also has an analgesic effect;
• anticonvulsants: finlepsin (carbamazepine), gabapentin, lyrica.

These drugs are used both simultaneously and separately. Significant effect is observed after 4-8 weeks of treatment.

When muscle pain is observed after a stroke, treatment is usually aimed at eliminating muscle spasticity. For this purpose, muscle relaxants (sirdalud, baclosan, mydocalm), positional treatment, physiotherapy procedures (thermotherapy or cryotherapy), massage and special therapeutic exercises are used.

However, if any pain occurs after a stroke, it is most rational to consult a doctor who will select the most effective drug in each specific case.

Physiotherapy for Post-Stroke Pain

To treat pain after a stroke, various physiotherapeutic treatments are widely used: electrotherapy (SMT, DDT, electrophoresis of drugs, electrical stimulation of paretic muscles), laser therapy, magnetic therapy, heat therapy (paraffin and ozokerite therapy), massage, therapeutic exercise, acupuncture.

Traditional methods of treating pain after a stroke

Rubbing with oils helps restore sensitivity to the extremities. Baths of pine needles, rosehip decoction (roots), and celandine also have an effect.

To rub the parts of the body that are paralyzed by a stroke, you can prepare a special ointment. The recipe is alcohol and vegetable oil in a 1:2 ratio.

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Prevention of pain after stroke

Pain after a stroke can be caused by various factors. To prevent its occurrence, doctors advise following these recommendations:

• avoid hot baths;
• do not allow the body to become tightly grouped;
• do not wear too light clothing;
• avoid putting pressure on the affected side;
• be in a comfortable body position;
• use devices for limbs that are weak or paralyzed;
• When sitting or lying down, fix the paralyzed arm on a special support (pillow, armrest) so that the pain in the shoulder after a stroke is not aggravated by the weight of the arm.
• while walking, it is advisable to have another person support you.

Pain after a stroke can and should be treated. Post-stroke pain syndromes vary in their mechanisms of manifestation and treatment methods. Timely treatment by a doctor is the key to a speedy recovery.