Pain

 

Neuropathic pain

Between 5% and 20% of stroke patients experience neuropathic or central post-stroke pain.

There may be some overlap with both spasticity which can cause pain, and with sensory loss which can be associated with unpleasant sensory phenomena.

It tends to affect younger patients and those with few physical disabilities.

Neuropathic or central post stroke pain may occur at different times following stroke, occurring up to several months later. Usual painkillers often have little effect on this type of pain but it can be treated. In some cases anti-depressant (amitriptyline) and anti-epileptic drugs (gabapentin or pregabalin) are prescribed for central post stroke pain. Side effects include drowsiness and dizziness but mainly occur at higher doses in elderly patients. A patient should be referred to their own doctor who may suggest onward referral to a pain clinic.

Patients with neuropathic or central post- stroke pain may:

• Have some sensation but be unable to differentiate between hot and cold, for example
• Experience normal touch as unpleasant and painful
• Feel more pain with emotional stress, cold or movement
• Avoid using certain body parts in rehabilitation activities and daily activities
• Become low in mood
• Become fatigued due to a lack of sleep
• Find relationships difficult to maintain; for example, hugging a loved one may be painful
• Have a poorer quality of life