Neuropathy After Stroke: Understanding & Treating Nerve Pain

Stroke is a serious, life-changing injury that can result in a wide variety of secondary effects. Among these secondary effects is nerve pain, or neuropathy. This type of chronic pain condition can be frustrating for survivors, but fortunately there are ways to treat it.

Neuropathy after stroke can be tricky to diagnose and can present in a variety of ways. Before you consider treatment, it’s important to understand the different types of neuropathy after stroke and to discuss your treatment options with your healthcare team. To help you better understand nerve pain after stroke, this article will review the causes of neuropathy, different types, and treatment options.

Can a Stroke Cause Neuropathy?

Many people wonder if a stroke can cause neuropathy, and the answer is “it depends.” Also referred to as nerve pain, neuropathy can present in different forms. This means that the cause and symptoms an individual may experience depends on the type of neuropathy, such as peripheral or central.

Peripheral neuropathy, the first type of neuropathy, is a co-occurring condition that stems from localized nerve damage. This means this specific type of nerve pain was not caused by the stroke, but rather by damage to the nerves outside of the brain and spinal cord.

Peripheral neuropathy feels like pain or numbness in one area of the body and typically affects the hands and feet, although it can occur elsewhere. This condition is caused by damage to peripheral nerves and nerve endings rather than the brain. Examples of causes of peripheral neuropathy include a traumatic injury, diabetes, or an infection.

If you have central neuropathy, the second type of neuropathic pain, then the stroke may have caused it. That’s because this type of neuropathy stems from damage to the central nervous system, which includes the brain.

Central neuropathy often affects the same areas of the body as the stroke itself and can be debilitating for survivors. Since a stroke is also known as a “brain attack,” you can see how the two conditions may be linked. To help further explain the link between stroke and nerve pain, we will discuss the cause of central neuropathy in the next section.

Causes of Central Neuropathy After Stroke

Central neuropathy is caused by dysfunction of the central nervous system. This type of nerve pain is commonly referred to as central poststroke pain (CPSP) and  affects around 1-8% of stroke survivors. Although research on CPSP has grown in recent years, evidence for the pathology and treatment of this type of nerve pain after stroke is still limited.

Central neuropathy is typically characterized by a burning sensation, pins-and-needles sensation, or intense stabbing or searing pain. In addition to these painful symptoms, central neuropathy can increase sensitivity to tactile stimulation. For example, a gentle breeze across the skin can feel like razor blades or intense burning. This type of pain is chronic and can still be present even if the survivor has diminished sensation in those areas of the body.

Central neuropathy occurs when the central nervous system (i.e. the brain or spinal cord) are injured from a serious event like stroke, traumatic brain injury, or spinal cord injury. In the case of a stroke, this nerve pain is the result of tissue damage within the brain.

It was formerly thought that central poststroke pain was solely due to injury to the thalamus, an area deep within the brain. However, we now know this condition can be the result of damage to many other areas of the brain as well.

Diagnosing Central Neuropathy After Stroke

Although pain is a common experience for stroke survivors, this symptom is often overlooked and not thoroughly managed. Central neuropathy after stroke can be difficult for your doctor to diagnose because it often develops months or even years after stroke. In fact, survivors of stroke can develop central neuropathy as late as 6 years following their initial injury.

In addition to symptoms that are often vague or difficult to localize, this delayed onset can lead to misdiagnosis. However, it’s critical to avoid misdiagnosis because treatment for localized pain does not work for central neuropathy.

Therefore, it’s a good idea to keep notes about your recovery from stroke all in one journal or folder and bring that with you to every doctor appointment. If you can provide a written record of your symptoms and stroke recovery timeline, it will help illustrate the problem for a more accurate diagnosis. Once you receive an appropriate diagnosis for your nerve pain after stroke, you can then begin targeted treatment.

Treatment for Nerve Pain After Stroke

Peripheral neuropathy and central neuropathy after stroke are both treated differently because they have different causes. To help you understand the differences, we will first discuss peripheral neuropathy treatment and then move on to central neuropathy treatment.

Peripheral Neuropathy Treatment

With peripheral neuropathy after stroke, pain is localized in one area of the body and is caused by nerve damage. Since this damage does not stem from the brain itself, this type of nerve pain requires different treatment methods. For example, your doctor may consider the following treatments:

• Pain medication. Over-the-counter medication may help with mild symptoms. If the pain is more severe, doctors may recommend prescription pain medication.
• Anticonvulsants. Gabapentin and pregabalin are used to treat seizures but may also be used to relieve nerve pain. One drawback is that these medications can cause unwanted side effects such as dizziness and lack of coordination.
• Topical pain relievers. Lidocaine patches or pain relief creams applied to the skin may help numb the area to provide temporary pain relief.
• Antidepressants. In some cases, certain tricyclic antidepressants have been found to help relieve neuropathic pain.

Central Neuropathy Treatment

Central neuropathy is often treated with more aggressive treatment methods as this type of nerve pain stems from the central nervous system. This can be a mix of pharmacologic and non-pharmacologic treatments. Here are some treatments used for central neuropathy/central poststroke pain:

• Anticonvulsants. Medications used to treat seizures may help with central neuropathy after stroke. This is because these medications can decrease the excitability of neurons (nerve cells) that send pain signals.
• Antidepressants. A specific antidepressant called amitriptyline is the first-line drug for central neuropathy after stroke. However, a high dose is not commonly tolerated in stroke patients and may be accompanied by intense side effects.
• Corticosteroids. Some corticosteroids like prednisone may help relieve central poststroke pain. These have also been shown to provide enhanced pain relief when combined with anticonvulsants.
• Exercise. Physical therapy exercise after stroke isn’t just good for improving mobility, but can also reduce nerve pain symptoms. In one study, physical therapy focusing on motor training and mirror therapy reduced CPSP symptoms for a survivor of thalamic stroke. This is largely due to the brain’s neuroplasticity, or the ability to create and rewire neural pathways.
• Electroacupuncture. This refers to electrical stimulation applied via acupuncture needles inserted into the body. Electroacupuncture has been found to help relieve central poststroke pain.
• Deep-brain stimulation. This is an invasive treatment that involves placing small electrodes deep within your brain to stimulate your central nervous system. One study called it an excellent treatment option for central poststroke pain, although this would likely be a last resort.
• Repetitive transcranial magnetic stimulation. This cutting-edge treatment may help central neuropathy, particularly when damage to the thalamus is the source of the neuropathic pain. This treatment involves the use of electrodes to deliver electromagnetic pulses over specific areas of the cerebrum.

Coping with the Psychological Effects of Neuropathy After Stroke

Pain is one of the most common yet most undertreated secondary effects of stroke. Nerve pain or neuropathy, specifically central poststroke pain, can be debilitating and lead to a loss of independence and daily function. This can contribute to conditions such as poststroke depression or feelings of grief after stroke.

As you explore your treatment options, it can be difficult to maintain a positive outlook on your recovery. Chronic pain is a demanding condition, and it will help to build a support system during this time. Call on friends and family to lift your spirits and consider joining support groups in-person or online. Also, keep track of your progress in a journal so you can document your small victories and look back on the gains you’ve made.

Aside from the psychological effects that neuropathy after stroke can have, this can cause other physical concerns as well. Since neuropathy can alter your sensation in the affected areas, you may be more at risk for balance loss (if it occurs in your feet) and more prone to injury. It is important to address these concerns with your doctor and therapists to maximize your safety.

Next Steps for Nerve Pain Management After Stroke

Central neuropathy after stroke is a serious condition and can sometimes be classified as central postroke pain. Central neuropathy tends to develop months or even years after stroke and can present with a wide variety of symptoms. If you have concerns about central neuropathy, it is important to discuss your specific symptoms with your medical team to avoid misdiagnosis and begin treatment.

Treatment for nerve pain after stroke such as central neuropathy can consist of medications, exercise, and modalities like repetitive transcranial magnetic stimulation. If these treatments are not effective at reducing your painful symptoms, more intense or invasive treatments like deep brain stimulation may be considered.

In the meantime, stay connected, stay encouraged, and keep searching for solutions for neuropathy after stroke. Tracking your progress and working toward small goals can help you stay motivated to pursue stroke recovery.