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Pain After Stroke Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Pain after stroke After a stroke you might experience various physical effects, such as weakness, paralysis or changes in sensation. Unfortunately you may also experience pain. This factsheet will help you to understand some of the causes of pain after stroke and the treatments that may be available. It also gives details of useful organisations that can provide you with further information and support. There are many different types of pain you Spasticity happens when there is damage may experience after having a stroke. to the area of your brain that controls your Weakness on one side of your body is one muscles. If you have spasticity you will have of the most common effects of stroke. This increased muscle tone. Muscle tone is the can lead to painful conditions such as muscle amount of resistance or tension in your stiffness (spasticity) and shoulder problems. muscles, and it is what enables us to hold our Some people also experience central post- bodies in a particular position. This increased stroke pain, headaches and sore swollen muscle tone can make it difficult to move hands after stroke. your limbs. Spasticity may also cause your muscles to tense and contract abnormally, As with many effects of stroke, pain may causing spasms, which can be very painful. persist for some time, but treatments Spasticity can also damage your tissues and such as medication and physiotherapy joints and can sometimes cause painful night are often successful in relieving pain. cramps. Many people also benefit from attending pain management clinics and learn coping It is important to treat spasticity as soon as techniques to help them to manage any possible because your joints and muscles long-term pain (see page 7 for details). may become so stiff that it is impossible to move them (this is called a contracture). Spasticity and contractures How is spasticity treated? After a stroke you may find that you have muscle tightness or stiffness – this is If you have weakness after your stroke you called spasticity. It is a common problem should be assessed for spasticity. A team of and affects over a third of stroke survivors. specialists will decide on the best treatment Usually it occurs on the weaker side of your for you. This may include a combination of body. physiotherapy, medication and Botox. Stroke Association – September 2012 1 Pain after stroke Physiotherapy medication to help reduce this stiffness and the pain that often accompanies muscle If you have spasticity you should have spasms. There are different types of drugs physiotherapy every day to move your that you could be given. They all work in joints. This will help to stretch your slightly different ways, but they all help to muscles, keeping them flexible and relax your muscles. When your muscles are reducing the possibility of contractures. relaxed they can move more easily and you Your physiotherapist will gently place can stretch them further. You may also find your affected limb into as many different that it becomes easier to straighten or bend positions as possible. This is called passive your affected limbs, and you may notice stretching and should be taught to your fewer muscle spasms. family and carers so that they can help you to practise your exercises. See our factsheet You will usually be prescribed baclofen or F16, Physiotherapy after stroke for more tizanidine first. If these drugs do not work, information. there are other drugs that may help, but they should only be prescribed by someone who Botox specialises in managing spasticity. If spasticity affects only one or two specific How are contractures treated? parts of your body, you may be given botulinum toxin A (Botox) as an injection Splinting and casting directly into your muscle. Botox works by blocking the action of the nerves on the If your spasticity is not fully controlled muscle, reducing your muscle’s ability to and you develop contractures, your contract. It reduces muscle tone, which can physiotherapist may use a splint or a cast help you to straighten out your limbs. that moulds to or lies along your affected Botox is only useful for small muscles, such limb and holds it in place. This treatment as those in the hands. The muscle-relaxing helps to stretch out the muscles in your effects of Botox usually last for about three tight limbs and is usually combined with months and you should not notice any physiotherapy. Sometimes this treatment changes in sensation in your muscles. is used to try to prevent contractures from forming by making sure that your body is Botox treatment should be given with further not in an abnormal position. Unfortunately rehabilitation such as physiotherapy, or sometimes splints and casts can be other treatments like splinting or casting. uncomfortable. Talk to your physiotherapist You should also have an assessment three to about what would be best for you. four months after the treatment, and be offered further Botox treatments if Surgery helpful. If you have severe contractures, you may Medication need surgery to lengthen your tendons. Tendons are the bands that connect your If you find that you are still experiencing muscle to the bone, and lengthening your muscle stiffness, you may be prescribed tendons allows the joint to be stretched 2 Stroke Association – September 2012 Pain after stroke out. This procedure is performed under How is shoulder pain treated? anaesthetic. Surgery is always a last resort. Prevention Shoulder pain If you have weakness in your arm following Shoulder pain is common after a stroke, and your stroke, your medical team will try to usually affects the side of your body that is prevent shoulder pain developing. They will affected by the stroke. There are different make sure that anyone who handles your arm types of shoulder pain that you might knows how to do so with care and without experience and experts do not yet fully causing strain on your shoulder joint. understand the exact causes. They should also ensure that your arm and Frozen shoulder shoulder are positioned correctly. Correct positioning is vital because it can help to After a stroke you may find that your reduce the strain on your ligaments and shoulder is very stiff and that it hurts capsule, helping to prevent frozen shoulder when you move it. This is called frozen from developing. It may also help to prevent shoulder or capsulitis. Muscles and ligaments your shoulder blade and upper arm bone around our shoulder joints hold the bone from moving apart (subluxation). Your in our upper arms in place. There is a layer medical team may use foam supports to of tissue that surrounds this joint which is make sure that your shoulder is supported called a capsule. If your arm muscles are very in the correct position. Your arm can also weak, stiff or paralysed, the effect of gravity be supported using a pillow. Overhead puts a strain on your ligaments and your arm slings should not be used because capsule. This can cause these parts of your there is not enough evidence that they shoulder joint to become inflamed, stretched work and they may increase your risk of and damaged. Having weakness in your arm developing shoulder pain or contractures. muscles may contribute to this pain in your Your physiotherapist may use cuffs or straps shoulder. to keep your arm and shoulder in the correct position, but for some people this may lead Subluxation to spasticity. Another cause of shoulder pain is shoulder Your physiotherapist may also use electrical subluxation. This means partial dislocation stimulation on the muscles around your – where the bone of the upper arm and the shoulder to help prevent or treat subluxation. shoulder blade have moved apart. This might (See page 6 for further information about be because the muscles that normally hold electrical stimulation.) this joint in place are too weak to do this properly. Reducing pain You may be given painkillers such as paracetamol or codeine to help relieve the pain in your shoulder. For more severe pain you may be given a non-steroidal Stroke Association – September 2012 3 Pain after stroke anti-inflammatory drug (NSAID) such as Some people find this pain becomes worse diclofenac or ibuprofen. These types of because of other factors such as movement drug help to relieve pain and can also help to or a change in temperature. reduce swelling in your shoulder capsule. The exact cause of CPSP is unknown, but it If you have an inflamed shoulder asteroid , is thought to be due to damage to certain such as triamcinolone, may be injected into parts of the brain and body. CPSP is a form your joint to help reduce the pain. Botox can of neuropathic pain, which means that the sometimes be injected into specific muscles painful sensation does not occur because around your shoulder to help reduce pain your body is injured or because something and increase flexibility, particularly where is making it hurt. the pain is associated with spasticity. The pain may be caused by damage to the Moving your shoulder brain, brainstem or spinal cord (together, these are called the central nervous It is important to keep the muscles in system) or be due to damage to the sensory your shoulder and arm active so that pathways. These are pathways between the any stiffness does not get worse. Your brain and the body which carry messages physiotherapist may use stretching about pain. In some cases, CPSP is due to exercises to move your shoulder joint in all damage to the thalamus, which is the brain’s directions.
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