Stroke painful
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Summary
10 papers analyzed
These studies suggest that post-stroke pain is common, often underdiagnosed, and can significantly affect the quality of life for stroke survivors.
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Understanding Pain After Stroke: Prevalence, Types, and Management
Prevalence of Post-Stroke Pain
Pain is a common and significant complication following a stroke, affecting a substantial proportion of stroke survivors. Studies indicate that post-stroke pain (PSP) occurs in 19-74% of patients, with central post-stroke pain (CPSP) being a notable subtype, albeit with a lower prevalence of 1-8% . This pain can be persistent and often resistant to treatment, severely impacting the quality of life of those affected .
Types of Post-Stroke Pain
Central Post-Stroke Pain (CPSP)
CPSP is a chronic neuropathic pain syndrome that arises due to the brain lesion itself. It is characterized by constant or intermittent pain, often described as burning or sharp, and is associated with sensory deficits in the area of the body corresponding to the stroke lesion . The pathogenesis of CPSP is not fully understood, but it is believed to involve hyperexcitation in damaged sensory pathways or damage to central inhibitory pathways.
Musculoskeletal Pain
Musculoskeletal pain, including shoulder pain and pain related to spasticity, is another common type of PSP. This pain can result from joint subluxation, spasticity, or other musculoskeletal disorders, and it often leads to chronic suffering and functional loss .
Complex Regional Pain Syndrome (CRPS)
CRPS is a less common but severe form of PSP that involves intense pain, swelling, and changes in the skin. It typically affects the limbs and can significantly impair mobility and function .
Headache and Other Pain Syndromes
Headaches and other pain syndromes, such as atypical facial pain and episodic pain, can also occur post-stroke. These types of pain may be episodic, transient, or persistent and can sometimes be the initial presentation of a stroke .
Management of Post-Stroke Pain
Pharmacological Treatments
Adrenergic antidepressants are often the first-line treatment for CPSP, although their effectiveness is frequently incomplete. Antiepileptics like lamotrigine and GABAergic drugs such as gabapentin or pregabalin have shown potential as adjunctive therapies . Opioids have been studied for their efficacy in PSP, but the results are inconclusive, and their use remains debated due to potential side effects and the risk of dependency.
Non-Pharmacological Treatments
Non-pharmacological treatments, including motor cortex stimulation, deep brain stimulation, and transcranial magnetic stimulation, have shown promise in certain groups of patients with CPSP . Physical therapy, movement therapy, and other rehabilitation interventions can also be beneficial for managing musculoskeletal pain and spasticity-related pain.
Psychological Interventions
Psychological interventions may help reduce chronic post-stroke pain, although the evidence is limited and further research is needed to confirm their efficacy.
Conclusion
Post-stroke pain is a prevalent and multifaceted issue that significantly impacts the quality of life of stroke survivors. Understanding the different types of PSP and their management options is crucial for improving patient outcomes. While pharmacological treatments provide some relief, non-pharmacological and psychological interventions also play a vital role in comprehensive pain management. Further research is essential to develop more effective treatments and improve the quality of life for those affected by post-stroke pain.
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