Pain perception after stroke
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Prevalence and Types of Pain After Stroke
Pain is a common and significant problem for stroke survivors, with studies showing that up to 40% of individuals experience pain to some degree several years after their stroke, and about 21–32% report moderate to severe pain in the months following the event Westerlind2020Jönsson2005Paolucci2015. Pain after stroke can be constant and is often perceived as more intense compared to pain in people without stroke . The types of pain experienced include central post-stroke pain (CPSP), musculoskeletal pain, shoulder pain, spasticity-related pain, and headaches, with musculoskeletal and shoulder pain being more prevalent in the subacute and chronic stages Paolucci2015Delpont2018.
Central Post-Stroke Pain (CPSP): Features and Mechanisms
CPSP is a neuropathic pain syndrome that affects about 2–12% of stroke survivors Andersen1995Kattan2013Klit2009+1 MORE. It is characterized by pain and sensory abnormalities in body parts corresponding to the area of the brain affected by the stroke. CPSP is often associated with symptoms such as burning, tingling, and pain evoked by cold, as well as sensory loss and hypersensitivity (allodynia and hyperpathia) Igawa2025Klit2009Barbosa2022. The pain is usually lacerating or aching and can be constant or intermittent Andersen1995Barbosa2022. CPSP is linked to lesions in the spino-thalamo-cortical pathways, and specific brain regions such as the putamen, insular cortex, and internal capsule are often involved Igawa2025Kattan2013.
Sensory Dysfunction and Pain Perception
Stroke survivors with pain often show abnormal sensory responses, including decreased sensitivity to temperature, touch, and pain, as well as cold hypoesthesia and hyperalgesia Andersen1995Igawa2025Barbosa2022. Quantitative sensory testing reveals that cold hypoesthesia is a strong indicator of neuropathic pain after stroke Igawa2025Barbosa2022. These sensory changes are related to both the location and the extent of brain lesions and white matter disconnections .
Impact on Quality of Life and Psychological Health
Pain after stroke is associated with reduced quality of life, poorer self-perceived health, and worse recovery outcomes Westerlind2020Jönsson2005. Depression and restricted mobility are more common in those experiencing frequent or severe pain Westerlind2020Jönsson2005. Many stroke survivors believe their pain is permanent and are less likely to think their actions can influence their pain, indicating a need for better education and support .
Treatment and Management Challenges
Despite the high prevalence and impact of pain after stroke, it remains underdiagnosed and undertreated, especially for neuropathic pain syndromes like CPSP, where fewer than 25% of patients receive appropriate drug treatment Paolucci2015Delpont2018. Standardized follow-up care and targeted educational interventions are recommended to improve pain management and patient outcomes Haslam2019Westerlind2020Delpont2018.
Conclusion
Pain perception after stroke is complex, involving both neuropathic and non-neuropathic mechanisms, and is influenced by sensory dysfunction, brain lesion characteristics, and psychological factors. It significantly affects quality of life and recovery, yet remains underrecognized and undertreated. Improved clinical assessment, patient education, and tailored interventions are essential to address the unique pain experiences of stroke survivors Haslam2019Westerlind2020Jönsson2005+5 MORE.
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