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: [email protected] 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
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