Finding relief from central post stroke pain – a chronic pain disorder after stroke – can be difficult. But in most cases, some relief is possible.
We can’t sugar coat this condition, though. The chronic pain that develops can severely affect quality of life. Therefore, central post stroke pain treatment should be prioritized.
To help you work alongside your medical team, here’s everything you need to know about central post stroke pain diagnosis and treatment.
Causes of Central Post Stroke Pain
The thalamus is the part of the brain that regulates 98% of all sensory input, including touch and pain. Researchers have established that injury of the “spino-thalamo-cortical pathway” is a requirement for central post stroke pain to exist.
The spino-thalamo-cortical pathway is a sensory pathway from the skin to the thalamus. When this pathway is damaged, it can distort sensation.
When this distortion becomes chronic – like with central post stroke pain – then even gentle sensations (like a light breeze across the skin) can be perceived as chronic pain (daggers across the skin).
Symptoms of Central Post Stroke Pain
Understanding the symptoms of central post stroke pain is critical for helping your medical team achieve an accurate diagnosis and proceed with treatment.
Because while nociceptive pain (the kind of pain you feel when you stub your toe) goes away on its own – central post stroke pain does not. In fact, it can get worse over time.
Here are the most common symptoms of central post stroke pain:
- Extreme pain. Often feels sharp, throbbing, stabbing, shooting, or burning
- Unrelenting. Chronic pain that either comes and goes or remains constant
- Excessive sensory reactions. Sharp bursts of pain can be caused by a gentle touch
- Extraneous pain. Pain seemingly without a cause. For example, a patient can have zero sensation in a limb when touched but still experience extreme, unrelenting pain
- Delated onset. Central post stroke pain often develops months or years after stroke
It’s important to note that some patients develop central post stroke pain within several months, but it has also been reported to develop 1-6 years after stroke.
With stroke side effects that have delayed onset like this, it’s helpful if you can identify the symptoms and then present the facts to your medical team.
Because if you are no longer seeing doctors that specialize in stroke, they may not be familiar with this condition. You can save yourself wasted time and misdiagnoses by knowing the facts beforehand.
Central Post Stroke Pain Treatment
Now that you understand the cause and symptoms of central post stroke pain, let’s dive into the treatment options.
This condition has a reputation of being difficult to treat, so you might have to work closely with your doctor until you find a suitable fit.
Some patients won’t respond at all, and some may find partial or, in rare cases, full relief. You’ll never know until you start experimenting with treatment.
Here are the best central post stroke pain treatment options:
Central post stroke pain rarely responds to painkillers because it’s a type of central neuropathic pain. Instead, antiepileptic and antidepressant medications have been shown to provide moderate relief in some patients.
Here are some common drugs prescribed for central post stroke pain treatment:
- Gabapentin. An antiepileptic agent that is effective and well-tolerated by most patients.
- Pregabalin. Another antiepileptic agent that has shown moderate results for managing central post stroke pain. Side effects can be serious, so it’s often used when other drugs don’t work.
- Anitriptyline. An antidepressant that has been shown to have above-average results in a small study.
- Lamotrigine. An antiepileptic drug that is usually well-tolerated with moderaly effective results (44% of patients responded to it).
These prescription drugs carry serious potential side effects, so it’s important to discuss those with your doctor before beginning treatment.
2. Mirror Therapy
Mirror therapy has been used for phantom limb pain – and now it’s starting to emerge as a potential central post stroke pain treatment, too.
It involves placing a tabletop mirror over the affected limb and performing physical therapy exercises with the non-affected limb.
This “tricks” the brain into thinking you’re moving your affected limb and initiates neuroplasticity – the mechanism your brain uses to rewire itself.
In one study, mirror therapy helped reduce central post stroke pain in a patient 5 years after thalamic stroke.
While more major studies are needed to prove the efficacy of mirror therapy for central post stroke pain, these results provide hope.
Other benefits of this treatment is its non-invasive nature and relatively low cost.
3. High and Low Frequency TENS Therapy
Another central post stroke paint treatment involves electrical stimulation.
Usually electrical stimulation is not well tolerated by patients with central post stroke pain because the stimulus is too great.
However, when transcutaneous electrical stimulation is applied in alternating high- and low-intensity, it has been shown to help some patients with central post stroke pain.
Unfortunately, only 26% of patients experience pain relief in one small study. And in some patients, the treatment temporarily increased the pain.
However, this treatment option can be considered if medication does not work and your doctor deems it safe. Patients need to work with a physical therapist to learn where to place the electrodes.
4. Spinal Cord Stimulation
If the above central post stroke pain treatments don’t work, then you can consider a cutting-edge treatment called spinal cord stimulation.
This invasive treatment involves surgically placing a device under your skin that sends mild electric current to your spinal cord.
In one study, pain relief was reported as “fair” or “good” in half of patients.
Of the patients that elected to keep the permanent SCS system, 70% reported significant, long-term pain relief.
This is an invasive treatment, but it can provide hope when patients do not respond to other central post stroke pain treatments.
Hope for Central Post Stroke Pain Treatment
While central post stroke pain is a mysterious condition, there are several known treatments that may provide moderate relief.
The least invasive treatments involve mirror therapy and drugs with antiepileptic or antidepressant properties. More invasive treatments involve electrical stimulation.
Working closely with your medical team is necessary for an accurate diagnosis and treatment.
Even though some patients only experience partial relief, it can still substantially improve quality of life.
We wish you the best of luck as you continue on the road to recovery.