Pain After a Stroke. How Can You Manage It? Understanding Post-Stroke Pain.
Agnieszka Węgorzewska
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Many people who have had a stroke have to cope with very severe pain. Pain after a stroke affects the patient’s everyday life and can, at times, turn rehabilitation into an ordeal.
When it comes to stroke, there is a wide range of types of pain linked to damage in specific areas of the brain. A subarachnoid haemorrhagic stroke occurs when blood leaks out onto the surface of the brain. It usually does not produce the typical focal symptoms such as paresis or speech difficulties after a stroke, but it does cause an extremely severe, sudden headache. This is a situation that requires urgent medical attention, because such a haemorrhage can be fatal.
Another type of pain relates to the consequences of the stroke itself. Both haemorrhagic and ischaemic stroke can cause significant pain if the area of the brain responsible for processing pain signals has been damaged. A particularly important structure is the thalamus, through which pain impulses pass. In such cases, the patient may feel pain throughout an entire limb or across one side of the body.
Pain After a Stroke. Types of Pain.
In neurophysiology, pain after a stroke can be divided into nociceptive and neuropathic pain. This distinction matters in practice, because each of these mechanisms produces slightly different symptoms and responds differently to treatment.
Nociceptive pain is the body’s natural protective response to tissue damage, for example after an injury or surgery. It usually eases over time as healing progresses and responds fairly well to conventional pain relief.
Neuropathic pain, on the other hand, arises as a result of damage to the nervous system — whether central, meaning the brain and spinal cord, or peripheral, meaning the nerves. It usually has a burning, shooting and spontaneous character. Most often it is constant, but in some patients the symptoms flare up periodically and take the form of stabbing or burning pain of very high intensity.
- Pain can be triggered by touch alone or by a change in body position.
- The intensity of the pain may be affected by emotions, anxiety and strong auditory or visual stimuli.
- Depending on the site of the damage, paralysis, speech difficulties, tremor and seizures may also appear.
Neuropathic pain is a form of chronic pain and is treated as a distinct medical condition. Its mechanism is not fully understood, which is why it is not easy to treat. In practice, antidepressants and anticonvulsants are often used, because standard painkillers tend to be of little help. In some patients, intravenous treatment — for example a lidocaine infusion — can also bring relief.
Some patients also experience reduced sensation or other sensory disturbances. Particularly in ischaemic stroke, the sensory cortex or the pathways leading directly to it may be damaged. The patient then feels numbness in a limb or across one side of the body, and this reduced sensation increases the risk of burns and other injuries, because the natural warning signal is lost.
There is also pain that only appears some time after the stroke. This type of discomfort is most often linked to contractures, which can develop just a few weeks after a stroke if the patient does not receive consistent physical rehabilitation. In addition, secondary degenerative changes may develop in the joints, especially the shoulder, with the formation of calcifications and blocked movement. In such cases, moving the limb becomes very painful — but it is precisely well-managed comprehensive stroke rehabilitation that remains the foundation of care.
The symptoms of neuropathic pain vary enormously. In some patients it is a constant sensation of burning, scorching or stinging. In others the pain is sudden and piercing, resembling an electric shock. The discomfort can be triggered by a draught of air, contact with clothing, heat or cold. There can also be extreme reactions to a painful stimulus, a loss of sensation, or pain radiating beyond the area of the damaged nerve.
Pain after a stroke affects every aspect of a patient’s life. It reduces quality of life, makes rehabilitation harder, disrupts sleep, and affects behaviour, family relationships and the ability to concentrate. Successful treatment depends on correctly identifying the type of pain, choosing the right therapy, and on the patient’s own attitude and the support of loved ones. The better the mechanism of the pain is understood, the easier it is to plan effective care.
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