Coping with Post-stroke Pain

Central post-stroke pain (CPSP) is a neuropathic pain syndrome characterized by constant or intermittent pain occurring after stroke and associated with sensory abnormalities in the painful body part. Sensory symptoms almost always develop on the side contralateral to the CNS lesion. Exceptionally, unpleasant sensations occur (with delayed onset) on the side ipsilateral to the lesion. CPSP occurs in about 2-8% (1, 2) of patients following a stroke. A higher incidence of this type of pain was registered in aged subjects after a completed stroke (3). Central pain in stroke patients may begin with a different delay after a cerebrovascular accident. It is usually constant, but some patients may suffer from paroxysmal or episodic pain. CPSP is usually referred to as having a burning, aching, lancinating, pricking, lacerating, or pressing quality (1, 2). Its intensity is affected by external (e.g. changes in temperature) and internal events, body movements, visceral stimuli, emotions, and changes in mood. Anxiety and depression aggravate CPSP. The cerebrovascular lesions causing central neuropathic pain are usually located in the thalamus, in the suprathalamic area, and in the lower brain-stem. Traditionally, the thalamic lesion has been considered to be the most frequent cause of CPSP. Apart from thalamic lesions, cerebrovascular lesions in many other locations have been shown to cause this type of pain, the most important being the posterior limb of the internal capsule, the subcortical and cortical zones in the postcentral gyrus, the insular region, and the lateral medulla oblongata (Wallenberg syndrome) (2). It has been generally agreed that damage to spinothalamic