Pain After a Stroke : What Should You Know?

Pain After a Stroke

After a stroke, many patients experience significant pain problems. There are numerous potential causes and locations of pain. The pain can be generated by brain injury, lack of movement, bad posture, and psychological or medical effects. The range of post-stroke pain may include muscle or joint pain, severe headaches and other painful sensations. Examples of the most common post-stroke pain experiences are:

  • Spasticity and muscle contractions

  • Shoulder pain and frozen shoulder

  • Shoulder subluxation

  • Central nervous system pain

  • Headaches

  • Swelling pain, and distal swollen limbs 


Spasticity and muscle contractions after a stroke : A nervous system injury from a stroke causes abnormalities of muscle control. This can result in muscle contractions, muscle tightness or muscle spasm and can be quite painful. Long duration muscle spasms are known as spasticity or hypertonia. If they continue untreated, spasticity can shorten muscles and lead to muscle atrophy and joints stiffness. This results in significant pain when moving joints and muscles. Someone experiencing spasticity needs physiotherapy every day to stretch the muscles, move the joints, and improve flexibility. This will help reduce contractures. Contractures are permanent shortening of the muscles or joints that occur when the soft tissue under the skin loses elasticity. If a patient develops contractures, they need a splint or a cast to set and hold the correct position. This treatment can help stretch the muscles.


Shoulder pain and frozen shoulder after a stroke : Shoulder pain or frozen shoulder usually occurs on the affected side of the stroke. The affected side is subject to weakness and lack of movement. If the shoulder muscles are extremely weak, stiff or paralyzed, the effect of gravity puts a strain on ligaments and capsules. The joint capsule is a tough, connective tissue attached to the bones outside the cartilage and enclosing the joint cavity. The capsule holds the bones and other parts of the joint together. When the shoulder is significantly strained, shoulder joints can become inflamed and painful, with a limited range of motion. 


Shoulder subluxation after a stroke : Shoulder subluxation refers to a partial dislocation of the shoulder. The upper arm bone moves out from scapula bone. This can occur as a consequence of stroke-induced muscle weakness, and the muscles fail to hold the joint in place. To reduce and prevent shoulder pain, the medical therapist team will aim to set the arm and shoulder in the correct position using foam supports, arm sling, and shoulder taping. This helps reduce strain on the ligaments and capsule. The physical therapist may also use electrical stimulation on the muscles around the shoulder to improve muscle strength and reduce pain. It is important to keep the muscles in the shoulder and arm active. The physical therapist can use stretching exercises to move the shoulder joint in multiple directions to improve the range of motion. The therapist can also provide advice about specific exercises for a home program for shoulder pain in stroke patients.


Central nervous system pain after a stroke : Central nervous system pain, Some people who experience a stroke may get central post-stroke pain (CPSP). This happens when structures in the brain that interprets pain are affected by stroke. This is also known as neuropathic pain or central pain syndrome. There are assorted types of pain sensations including burning, stinging cold sensation, throbbing, shooting pain, and numbness on the affected side of the body. The pain can begin immediately after a stroke and increase over the ensuing months later. CPSP can be treated by using medication along with electrical therapy for reducing pain.


Headaches after a stroke : Headache after a stroke can happen for several reasons, including medication side-effect, subarachnoid hemorrhage stroke (bleeding on the surface of the brain), hydrocephalus. Additionally, causes of headache pain might be the same as before a stroke, such as migraines, stress or sleeplessness. You should consult with a doctor or other healthcare professional to identify the cause of headaches.


Swelling pain and swollen distal limbs after a stroke : Swelling on distal limbs can result from a stroke patient not moving their limbs for long periods of time. The swelling may result from fluid building up in the tissue in the absence of muscle movement. Painful swelling can make it more difficult for the patient to move their arm and hand. This can lead to further spasticity and immobility problems. To reduce swelling problems it’s best to raise the limb, keeping it higher than the heart while sleeping. Working with a physical therapist is crucial for improving the movement of the limb.  


Pain management programs can help post-stroke patients find ways to manage pain. And, in the long term significantly improve a patient’s quality of life. A team consisting of a doctor, nurse, physiotherapist, and an occupational therapist is the optimal post-stroke rehabilitation team offering integrated holistic treatment.