Pain can be an issue after a stroke
Even though a stroke itself doesn’t usually cause pain, it is not uncommon for patients to have pain afterwards. It affects 30 to 40 percent of stroke survivors but it is commonly underreported, underdiagnosed and undertreated, according to the American Stroke Association. It can include numbness, burning, aching and tingling.
“Depending on where you have the stroke, you can have a problem,” said neurologist Emilio Melchionna, MD, FAAN at Neurologists of Cape Cod in Hyannis. “The classic is from a stroke in the thalamus.”
When the thalamus is damaged, it affects the sensory system, causing it to give false signals of pain. The condition used to be called Dejerine Roussy Syndrome, but now it is referred to as post-thalamic stroke pain or central post-stroke pain.
“If you have a stroke anywhere along the sensory pathway, you can have this post-stroke pain, which is really a scar giving you false signals,” Dr. Melchionna said. “There is no pain but you are feeling it. It usually starts several months after the stroke because you have to have the scar build up and then just out of the blue, you have pain.”
That type of pain is usually treated with anti-seizure medications, like gabapentin or carbamazepine.
Orthopedic Pain
The second type of post-stroke pain is caused by orthopedic problems like being unable to walk or move your arm. That means your affected body parts get stiff because they don’t move like they should. Another issue is if a person is confined to a wheelchair their arm often hangs down, causing numbness and pain.
“That’s more pain from lack of movement, where the stroke caused a deficit, so the pain is from immobility and deconditioning,” Dr. Melchionna said. “Physical therapy is the mainstay for treatment. And that’s where people have to change from an immediate gratification kind of medicine, like you have a sore throat, and you take medicine and you’ll feel better. It’s a lifestyle change.”
In PT, stroke patients learn exercises that must be done at home as well as the physical therapy office. The exercises should be done every day, he said.
Know the F.A.S.T. Acronym
One of the most important things patients should know about a stroke is that acting quickly after stroke symptoms start can make the difference between having few residual effects to having extremely debilitating effects. Healthcare professionals use the acronym F.A.S.T. to remind people of what symptoms to look for when a stroke occurs.
F.A.S.T. stands for:
- F – Face: Does one side of the face droop or look different when a person smiles?
- A – Arms: Does the person have trouble with one arm drifting downward when they raise both arms?
- S – Speech: Is the person’s speech slurred or different?
- T – Time: Call 911 immediately.
Anyone who has any of these signs of stroke or witnesses someone who does should call 911 immediately. The paramedics will be able to start assessment right away and will call and alert the hospital that a possible stroke victim is on the way so the stroke team can be ready to move quickly when they arrive at the Emergency Department.
If the patient gets to the ED within three to four and a half hours (depending on the individual patient history) from the onset of the stroke, they can receive a clot-busting medication, Dr. Melchionna said.
Once a stroke patient arrives at the hospital, they can rest assured that they will get the best standard of care. Both Cape Cod Hospital and Falmouth Hospital were presented with a Get with the Guidelines Gold Plus Award for stroke care in 2024 from the American Heart Association and the American Stroke Association. The prestigious award is bestowed upon hospitals that use the best and most updated practices for stroke care to minimize patient disability.
