Left arm pain as a symptom of stroke
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Left Arm Pain as a Symptom of Stroke: Clinical Presentation and Mechanisms
Left arm pain can be an important, though sometimes overlooked, symptom of stroke. While weakness or numbness are more commonly recognized, pain—especially in the form of central post-stroke pain or complex regional pain syndrome (CRPS)—can also be a direct result of stroke-related brain injury 410.
Central Post-Stroke Pain and Limb Pain
Central post-stroke pain (CPSP) is a neuropathic pain syndrome that arises from lesions in the central somatosensory pathways, often following strokes affecting the thalamus, parietal lobe, or brainstem. CPSP can present as severe pain, allodynia (pain from normally non-painful stimuli), or hyperalgesia (increased sensitivity to pain) in the affected limb, including the left arm 47. Case reports have documented patients presenting with left arm pain and allodynia as the initial symptom of a right parietal lobe stroke, highlighting that limb pain can sometimes be the first or most prominent sign of a cerebrovascular event 57.
Complex Regional Pain Syndrome (CRPS) After Stroke
CRPS is another pain syndrome that can develop after stroke, most frequently affecting the hemiplegic (paralyzed) limb. It is characterized by severe, persistent pain, swelling, changes in skin color or temperature, and movement difficulties in the affected arm 12410. CRPS can occur in the left arm if the stroke affects the right hemisphere of the brain, leading to left-sided weakness and pain. In rare cases, CRPS may even develop in the limb on the same side as the stroke (ipsilesional), as reported in some patients .
Incidence and Predictors of Post-Stroke Arm Pain
Pain in the affected arm is common after stroke, with studies reporting that up to 90% of patients with arm weakness may experience pain, spasticity, or contracture within weeks to months after the event . The risk of developing pain is higher in patients with severe weakness, sensory loss, or shoulder subluxation 68. Shoulder pain, in particular, is a frequent complication and can significantly impact recovery and rehabilitation outcomes .
Clinical Implications and Management
Recognizing left arm pain as a possible symptom of stroke is crucial for timely diagnosis and management. Early identification and treatment of post-stroke pain syndromes, including CPSP and CRPS, can improve patient outcomes, reduce disability, and enhance quality of life 410. Non-pharmacological interventions such as mirror therapy have shown promise in reducing pain and improving function in the affected arm . Pharmacological treatments, including steroids for CRPS and medications like amitriptyline or pregabalin for neuropathic pain, may also be effective 17.
Conclusion
Left arm pain can be a direct symptom of stroke, resulting from central nervous system injury or secondary complications like CRPS. Clinicians should be aware that pain, including allodynia and hyperalgesia, may be an early or prominent sign of stroke, especially when associated with other neurological deficits. Prompt recognition and targeted management of post-stroke pain are essential for optimizing recovery and quality of life in stroke survivors 4510.
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