Misdiagnosing Post-Stroke Pain

Stroke patients may suffer debilitating pain that is treatable but often misdiagnosed

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Days or even weeks after a stroke, some patients experience intense pain. Medications and magnetic or electrical stimulation can help, but doctors often fail to correctly diagnose the condition.

Nearly 1 in 10 individuals who have had a stroke suffer from central post-stroke pain syndrome (CPSP). The condition causes a chronic sharp, stabbing or burning sensation.

When correctly identified, CPSP can be treated. However, many physicians often do not accurately identify the syndrome, according to a recent report.

"Tell your doctor if you're experiencing pain after a stroke."

Murray Flaster, MD, associate professor in the departments of Neurology and Neurological Surgery at Loyola University Chicago Stritch School of Medicine and medical director of the Loyola outpatient neurology clinic, co-authored the article with other scientists from Loyola University.

In reviewing previous research, Dr. Flaster and his colleagues found that about 8 percent of stroke patients experience CPSP, but it can range from 1 percent to 12 percent, depending on the study.

One investigation found that 63 percent of patients were affected within one month, 18 percent within six months and the remaining 18 percent after six months.

The affliction is a type of neuropathic pain caused by damage or dysfunction within the central nervous system.

For individuals with CPSP, the sensations can be extreme. They can experience hyperpathia (abnormally painful reaction to a painful stimulus) or allodynia (pain in response to a light touch or contact with clothing or bed sheets, air currents, etc.) Allodynia has been reported in two-thirds of CPSP patients.

Post-stroke patients may also deal with many other types of pain. These may include headache and musculoskeletal pain, especially pain related to abnormal shoulder movement.

“It is crucial to recognize CPSP and differentiate it from musculoskeletal pain or spasticity-associated pain,” wrote the authors. Spasticity refers to feelings of stiffness and a wide range of involuntary muscle spasms.

The researchers found descriptions of CPSP dating back to a medical journal in 1906. More than a century later, however, they say that CPSP is frequently misdiagnosed, and getting patients the relief they need requires correct recognition of the syndrome. 

Standard first-line treatments for CPSP include amitriptyline (an antidepressant) and lamotrigine (an anticonvulsant, brand name Lamictal). If patients don’t respond to those medications, physicians may try the anticonvulsant gabapentin (brand names Neurontin and Gabarone).

If medications fail to work, a non-invasive therapy called transcranial magnetic stimulation (TMS) should be considered, according to the investigators. TMS sends short pulses of magnetic fields to the brain.

If both medications and TMS do not provide relief, patients may consider invasive therapies that electrically stimulate the brain. Such treatments involve inserting electrodes into the membrane covering the brain (motor cortex stimulation) or into the brain itself (deep brain stimulation). This technique is only used on carefully screened patients.

“CPSP is treatable,” wrote Dr. Flaster and his team. “Recognition of the syndrome in and of itself can be reassuring to the patient."

The article, “Central Poststroke Pain: Current Diagnosis and Treatment,” was published in May in the journal Topics in Stroke Rehabilitation.

Reviewed by: 
Review Date: 
May 14, 2013
Last Updated:
August 13, 2013