After a stroke, some patients develop chronic, debilitating pain. Identifying it is the first step toward treating it.
About 10% of patients who suffer a stroke develop central post-stroke pain syndrome (CPSP). Typically described as a sharp, stabbing, or burning sensation, the pain can manifest days, weeks, or months after the cerebrovascular incident. One study found that among patients who experience CPSP, 63 percent were affected within one month, 18 percent within six months, and the remaining 18 percent after six months.
First described a century ago, CPSP is a form of neuropathic pain caused by damage or dysfunction within the central nervous system. When properly diagnosed, it is treatable with medications and magnetic or electrical stimulation of the brain. But physicians often fail to correctly diagnose the condition, according to an article written by specialists from Loyola University Medical Center. Central Poststroke Pain: Current Diagnosis and Treatment was published in the journal Topics in Stroke Rehabilitation.
According to authors Murray Flaster, M.D. and Ph.D., and Jose Biller, M.D., in the Department of Neurology and Murali Rao, M.D. and Edwin Meresh, M.D., Department of Psychiatry and Behavioral Sciences, post-stroke pain can manifest in different ways.
Some patients experience hyperpathia (abnormally painful reaction to a painful stimulus) or allodynia (pain in response to a light touch, contact with clothing, bed linens, air currents and other stimuli that normally don’t cause pain or discomfort.) Allodynia is reported in two-thirds of CPSP patients. It is among several types of post-stroke pain, which include headache and musculoskeletal pain, especially pain related to abnormal shoulder movement.
There are many causes of post-stroke pain, and these frequently coexist in our patients, the authors write. It is crucial to recognize CPSP and differentiate it from musculoskeletal pain or spasticity-associated pain.”
First-line drug treatments for CPSP include amitriptyline (an antidepressant) and lamotrigine (an anticonvulsant). Second-line treatment includes the anticonvulsant gabapentin.
If medications don’t work, a noninvasive therapy called transcranial magnetic stimulation (TMS) should be considered. TMS sends short pulses of magnetic fields to the brain.
If both drugs and TMS fail, invasive therapies that electrically stimulate the brain are an option for carefully selected patients. The treatments involve inserting electrodes into the membrane covering the brain (motor cortex stimulation) or into the brain itself (deep brain stimulation).
CPSP is treatable, the authors write. “Recognition of the syndrome in and of itself can be reassuring to the patient.”