8th August 2024

Pain

Pain is often encountered by patients with chronic neurological disability. Following a stroke, this is most commonly musculoskeletal and is related to paralysis and immobility.

Headache

Common following a stroke or due to medications used, such as GTN (glyceryl trinitrate). Manage with simple analgesia.

Hemiplegic shoulder pain

Hemiplegic shoulder pain or subluxation is related to muscular flaccidity and poor handling. Management is with prevention, physiotherapy, positioning and simple analgesia.

Central post-stroke pain

A neuropathic pain syndrome occurring following stroke. Characterised by pain in the areas affected by the stroke and can cause allodynia, hyperalgesia or abnormal sensations. Managed with neuropathic agents; may need Pain Team input.

Spasticity

Common due to upper motor neurone damage. Caused by hyperexcitability of the stretch reflex, resulting in functional impairment, risk of infection related to skin breakdown, pain and the development of contractures.

• Prevention: physical rehabilitation using a variety of techniques
• Management:
  • Physical rehabilitation
  • IM botulinum toxin (type A) for focal spasticity – well tolerated with minimal side effects
  • Trial of oral baclofen or tizanidine – use is limited to generalised spasticity or progressive neurological conditions due to side effects of drowsiness, fatigue and weakness