Stroke’s Little Known Complication – Pain

Many people have a general familiarity to the obvious symptoms of stroke complications: paralysis, thinking and concentration deficits, speech problems, emotional difficulties, and daily living problems. However, many are unaware of the possible pain complications.

A 29 year old stroke victim in the magazine Stroke Connection provided vivid detail of his stroke pain,

Someone is ripping at my arm, hand, face and foot with razorblades constantly. My fingers are made of metal worms that move constantly. My arm and other bones are broken and sticking out of my skin… I know that’s difficult to imagine, but it’s difficult to explain the evil, horrific, non-stop ripping, clawing, beating, burning,…on and on…and it never stops, even for one second, it’s constant and will not stop and you endure it for the rest of your life!

This condition, central pain syndrome, is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. It is characterized by sensory changes and nerve pain. In addition to stroke, central pain syndrome can be seen with multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson’s disease

Central pain syndrome is unexpected and bewildering to family members, caretakers, and even the stroke patient. Before them is a limb with little motion that is supposed to be devoid of feeling, yet these very same extremities are transmitting intense sensation. The pain is usually constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes, usually cold temperatures. Individuals experience one or more types of pain sensations, the most prominent being burning. Along with the burning may be pressing, lacerating, or aching pain; sensations of “pins and needles”; and brief, intolerable bursts of sharp pain similar to the pain caused by an exposed nerve. Individuals may have numbness and burning in the areas affected by the pain, especially in the hands or the feet. With the onset of the symptoms more than a month after the stroke, there is much confusion. The symptoms may be misinterpreted as depression or a reaction to a life jarring event. True enough, stroke is a life altering situation, but the pain described or experienced is real.

The increase in soldiers with traumatic brain and spinal cord injuries returning from the wars in Iraq and Afghanistan has focused more attention and research on the condition. Treatment at this time is limited. It includes use of antidepressants, anticonvulsants, narcotics, and anti-arrhythmics. The drug of first choice is the antidepressant amitriptyline. Newer techniques such as vestibular stimulation (introduction of water to the inner ear) have shown promising results in pain relief.

References

P. Hansson (2004). Post-stroke pain case study: clinical characteristics, therapeutic options and long-term follow-up European Journal of Neurology, 11 (s1), 22-30 DOI: 10.1111/j.1471-0552.2004.00793.x

P. D. McGeoch, L. E. Williams, R. R. Lee, V. S Ramachandran (2008). Behavioural evidence for vestibular stimulation as a treatment for central post-stroke pain Journal of Neurology, Neurosurgery & Psychiatry DOI: 10.1136/jnnp.2008.146738