F30 Pain After Stroke - Referenced_0

8/13/2019 F30 Pain After Stroke - Referenced_0

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F30 Pain after stroke - referenced

After a stroke you might experience various physical effects, such as weakness,paralysis or changes in sensation. Unfortunately you may also experience pain. Thisfactsheet will help you to understand some of the causes of pain after stroke and thetreatments that may be available. It also gives details of useful organisations that canprovide you with further information and support.

There are many different types of painyou may experience after having a

stroke. Weakness on one side of yourbody is one of the most common effectsof stroke. This can lead to painfulconditions such as muscle stiffness

spasticity! and shoulder problems."ome people also experience centralpost#stroke pain, headaches, and soreswollen hands after stroke.

As with many effects of stroke, painmay persist for some time, buttreatments such as medication andphysiotherapy are often successfulin relieving pain. $any people alsobenefit from attending painmanagement clinics and learn copingtechni%ues to help them to managelong#term pain see page & for details!.

Spasticity and contractures

After stroke you may find that you have muscle tightness or stiffness ' this iscalled spasticity. i It is a commonproblem and affects over a third ofstroke survivors. ii Usually it occurs onthe weaker side of your body .iii

"pasticity happens when there isdamage to the area of your brain that

controls your muscles. iv If you havespasticity you will have increased

muscle tone .v

$uscle tone is theamount of resistance or tension in yourmuscles, and it is what enables us tohold our bodies in a particular position. vi

This increased muscle tone can make itdifficult to move your limbs. vii "pasticitymay also cause your muscles to tenseand contract abnormally, causingspasms ,viii which can be very painful. ixxxi

"pasticity can also damage your tissueand (oints and can sometimes causepainful night cramps. xii

It is important to treat spasticity as soonas possible because your (oints andmuscles may become so stiff that it isimpossible to move them this is calleda contracture !.xiii

ow is spasticity treated!

If you have weakness after your strokeyou should be assessed for spasticity. xiv

A team of specialists will decide on thebest treatment for you. xv This mayinclude a combination of physiotherapy,medication and )otox.

Physiotherapy

"troke Association "eptember *+ *"troke -elpline + + + ++ website www.stroke.org.uk
http://www.stroke.org.uk/http://www.stroke.org.uk/


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usually combined with physiotherapy. xxxv

"ometimes this treatment is used to tryto prevent contractures from forming xxxvi by making sure that your body is not inan abnormal position. xxxvii Unfortunatelysometimes splints and casts can beuncomfortable. Talk to yourphysiotherapist about what would bebest for you.

Surgery

If you have severe contractures, youmay need surgery to lengthen yourtendons .xxxviii Tendons are the bandsthat connect your muscle to the bone,and lengthening your tendons allowsthe (oint to be stretched out. Thisprocedure is performed underanaesthetic. "urgery is always a lastresort. xxxix

Shoulder pain

"houlder pain is common after a stroke,and usually affects the side of yourbody that is affected by the stroke.There are different types of shoulderpain that you might experience and

experts do not yet fully understand theexact causes. xl

Fro%en shoulder

After a stroke you may find that your shoulder is very stiff and that it hurtswhen you move it. This is calledfro1en shoulder or capsulitis. $uscles

and ligaments around our shoulder (oints hold the bone in our upper arms

in place. There is a layer of tissue that

surrounds this (oint which is called acapsule. If your arm muscles are veryweak, stiff or paralysed, the effect ofgravity puts a strain on your ligamentsand your capsule. This can cause theseparts of your shoulder (oint to becomeinflamed, xli stretched and damaged.-aving weakness in your arm musclesmay contribute to this pain in your

shoulder.xlii

Sublu#ation

Another cause of shoulder pain isshoulder subluxation. This means partial dislocation xliii # where the boneof the upper arm and the shoulderblade have moved apart. xliv This mightbe because the muscles that normallyhold this (oint in place are too weak todo this properly. xlv

ow is shoulder pain treated!

Prevention

If you have weakness in your armfollowing your stroke, your medical

team will try to prevent shoulder paindeveloping. xlvi They will make sure thatanyone who handles your arm knowshow to do so with care and withoutcausing strain on your shoulder (oint. xlvii

They should also ensure that your armand shoulder are positionedcorrectly. xlviii &orrect positioning is

vital because it can help to reduce thestrain on your ligaments and capsule,



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helping to prevent fro1en shoulder from

developing. It may also help to preventyour shoulder blade and upper armbone from moving apart subluxation!. xlix

/our medical team may use foamsupports to make sure that yourshoulder is supported in the correctposition. l /our arm can also besupported using a pillow . li 'verheadarm slings should not be used liiliii

because there is not enough evidencethat they work liv and they may increaseyour risk of developing shoulder pain orcontractures. lv /our physiotherapistmay use cuffs or straps to keep yourarm and shoulder in the correctposition, but for some people this maylead to spasticity. lvi

/our physiotherapist may also useelectrical stimulation on the musclesaround your shoulder to help prevent ortreat subluxation. lvii "ee page 2 forfurther information about electricalstimulation.!

(educing pain

/ou may be given painkillers such as

paracetamol or codeine to help relievethe pain in your shoulder. lviii 3or moresevere pain you may be given a non#steroidal anti#inflammatory drug

4"AI5! lix such as diclofenac oribuprofen . lx These types of drug help torelieve pain and can also help to reduceswelling in your shoulder capsule. lxi

If you have an inflamed shoulder asteroid) such as triamcinolone, may be

in(ected into your (oint to help reduce

the pain.lxii

"oto# can sometimes bein(ected into specific muscles aroundyour shoulder to help reduce pain andincrease fle#ibility , particularly wherethe pain is associated with spasticity. lxiii

$oving your shoulder

It is important to keep the muscles in

your shoulder and arm active so thatany stiffness does not get worse. /ourphysiotherapist may use stretchinge#ercises to move your shoulder (ointin all directions. lxiv They can alsoprovide you with advice about how toprotect your shoulder during everydaymovements such as reaching forsomething or getting dressed.

&entral post-stroke pain &PSP !

Up to * per cent of people who have astroke will develop a particular type ofpain called central post#stroke pain

67"7!. lxv This is also known as5e(erine 8oussy "yndrome, lxvi or centralpain syndrome. lxvii

There are different types of pain lxviii youmight experience if you have 67"7.$any people describe it as an icyburning sensation , or a throbbing orshooting pain . "ome people alsoexperience pins and needles ornumbness in the areas affected by thepain. 3or most stroke survivors with67"7, the pain occurs in the side of

their body that has been affected by thestroke. lxix The pain may begin


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Increasing the amount of fluid in your

body will improve the blood circulationto your brain. xcv

"ometimes taking painkillers forheadaches too often for more thanabout + days a month! can causeheadaches. Treatment usually involvesstopping all pain relief medication forone month, but talk to your earning a relaxationtechni%ue, such as meditation or

yoga) xcvi or speaking to a counsellor

may also help you to cope.xcvii

A painclinic can give you more advice aboutyour options see page &!.

,ranscutaneous electrical nervestimulation 2,e1S

If you have severe and persistent pain,your medical team may consider

treating this with transcutaneouselectrical nerve stimulation Te4"!. xcviii

Te4" treatment uses electricalimpulses to reduce pain . "ticky padsare attached to your skin close to thearea that hurts. These pads are linkedto leads called electrodes, which areattached to a battery#operated machine.?lectrical impulses are then sent fromthe machine, through the electrodesand onto your skin. These impulses canhelp to block the pain signals fromtravelling along the nerve pathways xcix to your brain. At a low fre%uency, Te4"can help your body to release naturalpainkillers called endorphins. c

There is not enough evidence to say

definitively whether Te4" is an effectiveand reliable way of reducing pain.6linical trials have shown that it workswell for some people but not for others,and that the amount of pain relief andthe length of time that this lasts forvaries from person to person. ci Thema(ority of people who have foundTe4" to be effective noticed benefits

whilst the machine was switched on,but found the pain relief did not last. cii


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This form of pain management is widelyused by hospitals and pain clinicsthroughout most of the U@ see thesection on Pain clinics and painmanagement programmes !. Te4"could be a helpful way to manage yourpain but it is important to check withyour doctor first before trying thistreatment. This is because there are

lots of different causes of pain andtypes of pain, and Te4" has not yetbeen recommended for all of them. ciii

There are no side effects to Te4" andyou can use it alongside othermedication. Te4" is unsuitable forsome people , for example people fittedwith a cardiac pacemaker, civ so if youare interested in trying Te4" to manageyour pain, it is important to check withyour doctor first . Te4" treatment maybe available from your physiotherapist,or alternatively you can buy themachines from some pharmacies.

Pain clinics and painmanagement programmes

/ou should be referred to a specialistpain service if you are still in paindespite initial treatment, and it iscausing you distress or significantlylimiting what you are able to do. If thishas not happened, ask your doctor torefer you to one. cvcvi 7ain clinics andpain management programmes canhelp you to find ways to manage

your pain in the longer#term to improveyour %uality of life. cvii

At a pain clinic, you can have anassessment to determine the cause ofyour pain and they can providetreatment and advice to help you tomanage this pain. The kinds oftreatment that are available from painclinics vary across the U@. $oreinformation about what pain servicesare available for you can be obtained

from your local health service, forexample your


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management programme at the Walton

6entre for 4eurology and4eurosurgery. They are available fromthe 7ain 8elief 3oundation see Usefulorganisations !. TitlesC oping !ith Pain ,

oping !ith Back Pain , oping !ith"eadache and #igraine , $n%iety allpriced at DB.;+ inc. 7E7!, &he'ela%ation (it , and, Feeling )ood

D .FF inc 7E7!.

"ooks

&he Pain 'elief "andbook* +elf-helpmethods for managing pain )y 5r6hris Wells E ondon FF2. Available from bookshops.

&aking ontrol of your Pain )y Toni)attison. Age 6oncern )ooks *++;!

Available from book shops.

Pain 'elief !ithout rugs )y Han"adler. *++&! -ealing Arts 7ress priceD *.FF!. Available from The 7ain 8elief3oundation.

Useful organisations

All organisations are U@ wide unlessotherwise stated.

Stroke ssociationStroke elpline5 + + + ++6mail5 info stroke.org.uk 7ebsite5 www.stroke.org.uk 6ontact us for information about stroke,

emotional support and details of localservices and support groups.

ction on pain,el5 +B9; 2+ ;F7ebsite5 www.action#on#pain.co.uk 7rovides information and advice aboutpain. 6ampaigns and raises awarenessof those living with chronic pain.

,he "ritish Pain Society,el5 +*+ &*2F &B9+

7ebsite5 www.britishpainsociety.org -as various publications for patientsand information about painmanagement.

&entral Pain Syndrome lliance7ebsite5 www.centralpain.org International internet resource withonline information and a discussionforum for support.

&hronic Pain Policy &oalition,el5 +*+ &*+* B;B+7ebsite5 www.policyconnect.org.uk=cppc

A forum uniting professionals, membersof parliament and patients to campaignfor improved strateg ies on chronic painissues. Information about pain is available on

the website.

Pain ssociation Scotland,el5 +B++ &B 2+;F7ebsite5 www.painassociation.com 7rovides information about pain andruns self#management programmesacross "cotland for people living withchronic pain.

Pain &oncern


F
mailto:[email protected]://www.stroke.org.uk/http://www.action-on-pain.co.uk/http://www.britishpainsociety.org/http://www.centralpain.org/http://www.paincoalition.org.uk/http://www.painassociation.com/http://www.stroke.org.uk/mailto:[email protected]://www.stroke.org.uk/http://www.action-on-pain.co.uk/http://www.britishpainsociety.org/http://www.centralpain.org/http://www.paincoalition.org.uk/http://www.painassociation.com/http://www.stroke.org.uk/


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elpline5 + ++ * +&BF

7ebsite5 www.painconcern.org.uk Information and advice about pain isavailable through a range ofpublications and their helpline. 8uns aradio programme called Airing 7ain.They also have an online forum.

,he Pain (elief Foundation,el5 + ; ;*F ;B*+

7ebsite5 www.painrelieffoundation.org.uk 7rovides information about pain andpain management and supportsresearch into treatments.

PainSupport7ebsite5 www.painsupport.co.uk 7rovides information about pain reliefand advice about treatments. :ffers anonline forum and a contact club so thatpeople suffering from pain can contacteach other.

S&'P6elpline5 +B+B B++

7ebsite5 www.scope.org.uk 7rovides information sheets aboutspasticity, splinting and )otox

treatment.

,alking 8ife,el5 + ; 2 * +22*7ebsite5 www.talkinglife.co.uk 8uns training courses and producesmaterials for professionals. ,e1S $edical Services 8td

,el5 +B9; +F++ B++7ebsite5 www.tens.co.uk

7roduces and sells Te4" machines.

isclaimer5 The "troke Associationprovides the details of otherorganisations for information only.Inclusion in this factsheet does notconstitute a recommendation orendorsement.

9lossary of terms

&apsulitis J see K3ro1en shoulder0.

&entral nervous system J the namefor the system in the body containingthe brain, brainstem and spinal cord.

&ontracture J abnormal shortening ofa muscle that results in deformity.

&PSP J central post#stroke pain.

&erebrospinal fluid &SF ! J fluid thatfills the space between the brain andskull.

Fro%en shoulder J a very stiff shoulderwhich can be painful.

8umbar puncture J a procedure totake a sample of cerebrospinal fluid,which can be used to diagnoseconditions such as a subarachnoidhaemorrhage.

'edema J an increase of fluid in thetissues which can cause swelling.

Spasticity J a form of muscletightening.


+
http://www.painconcern.org.uk/http://www.painrelieffoundation.org.uk/http://www.painrelieffoundation.org.uk/http://www.painsupport.co.uk/http://www.scope.org.uk/http://www.talkinglife.co.uk/http://www.tens.co.uk/http://www.stroke.org.uk/http://www.painconcern.org.uk/http://www.painrelieffoundation.org.uk/http://www.painrelieffoundation.org.uk/http://www.painsupport.co.uk/http://www.scope.org.uk/http://www.talkinglife.co.uk/http://www.tens.co.uk/http://www.stroke.org.uk/


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Subarachnoid haemorrhage J a typeof stroke caused by bleeding in thespace between the brain and skull.

Subarachnoid space J the spacebetween the membranes that surroundthe brain and protect it from the skull.

Sublu#ation J partial dislocation of the

shoulder, where the bone of the upperarm and the shoulder blade havemoved apart.

,e1S J Transcutaneous electricalnerve stimulation a treatment that useselectrical impulses to block painsignals!.

7roduced by the "troke Association0sInformation "ervice. 3or sources used,

visit stroke.org.uk

L "troke Association

3actsheet +, version + published

"eptember *+ * next review due"eptember *+ 9!.

"troke Association is registered as a charity in ?ngland and Wales 4o * + ;! and in "cotland"6+ &&BF!. Also registered in 4orthern Ireland MT B+;! Isle of $an 4o F9;! and Hersey 47:2F!.

(eferences



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xxvii Warlow, 6. et al *++B!, +troke Practical management Third edition!, )lackwell7ublishingC :xford, p.;Bxxviii $arler, H. *++;!, +troke for ummies 3irst edition!, Wiley 7ublishingC Indiana, p.*&Fxxix $arler, H. *++;!, +troke for ummies 3irst edition!, Wiley 7ublishingC Indiana, p.*&Fxxx )ritish $edical Association, *+ reprint!, .e! )uide to #edicines and rugs ?ighthedition!, 5orling @indersley >imitedC >ondon, p. 2&xxxi

)ritish $edical Association, *+ reprint!, .e! )uide to #edicines and rugs ?ighthedition!, 5orling @indersley >imitedC >ondon, p.&B=9BFxxxii 8oyal 6ollege of 7hysicians and the 6linical ?ffectiveness E ?valuation Unit. *++B!.ational linical )uidelines for +troke . rd ?dn. >avenham 7ress >td "uffolk, p. BC2.*+. 3.xxxiii "cottish Intercollegiate avenham 7ress >td "uffolk, p.&B 2. 9xxxviii -arwood, 8. et al *++;!, +troke are a practical manual 3irst edition!, :xfordUniversity 7ressC 4ew /ork, p. &*xxxix -arwood, 8. et al *++;!, +troke are a practical manual 3irst edition!, :xfordUniversity 7ressC 4ew /ork, p.;B*xl "tein, H. et al *++F!, +troke 'eco ery and 'ehabilitation 3irst edition!, 5emos $edical C4ew /ork, p.99*.xli The )ritish $edical Association *++F!, /llustrated #edical ictionary "econd edition!,5orling @indersley >imitedC >ondon, p. +&xlii 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. *;xliii The )ritish $edical Association *++F!, /llustrated #edical ictionary "econd edition!,5orling @indersley >imitedC >ondon, p.;xliv 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass

7ublishingC >ondon, p.;;xlv 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p.;;xlvi 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p.;;xlvii 8oyal 6ollege of 7hysicians and the 6linical ?ffectiveness E ?valuation Unit. *++B!.ational linical )uidelines for +troke . rd ?dn. >avenham 7ress >td "uffolk, p. Bxlviii "cottish Intercollegiate ondon, p.;;
http://www.sign.ac.uk/guidelines/fulltext/118/index.htmlhttp://www.sign.ac.uk/guidelines/fulltext/118/index.htmlhttp://www.sign.ac.uk/guidelines/fulltext/118/index.htmlhttp://www.sign.ac.uk/guidelines/fulltext/118/index.html


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l 8oyal 6ollege of 7hysicians and the 6linical ?ffectiveness E ?valuation Unit. *++B!.ational linical )uidelines for +troke . rd ?dn. >avenham 7ress >td "uffolk, p. B and"t avenham 7ress >td "uffolk, p. B2.**. Aliii "cottish Intercollegiate


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lxvii 4ational Institute of 4eurological 5isorders and "troke, ./. + entral Pain +yndrome/nformation Page Han *+ !httpC==www.ninds.nih.gov=disorders=centralNpain=centralNpain.htm accessed 2th Huly*+ *!lxviii "tein, H. et al *++F!, +troke 'eco ery and 'ehabilitation 3irst edition!, 5emos $edicalC 4ew /ork, p.**lxix

"tein, H. et al *++F!, +troke 'eco ery and 'ehabilitation 3irst edition!, 5emos$edical C 4ew /ork, p.***lxx 4ational Institute of 4eurological 5isorders and "troke, ./. + entral Pain +yndrome/nformation Page Han *+ !httpC==www.ninds.nih.gov=disorders=centralNpain=centralNpain.htm accessed 2th Huly*+ *!lxxi 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. *lxxii Warlow, 6. et al *++B!, +troke Practical management Third edition!, )lackwell7ublishingC :xford, p.;B&lxxiii 4ational Institute of 4eurological 5isorders and "troke, ./. + entral Pain +yndrome/nformation Page Han *+ !httpC==www.ninds.nih.gov=disorders=centralNpain=centralNpain.htm accessed 2th Huly*+ *!lxxiv )eers, $ et al, *++ !, &he #erck #anual of #edical /nformation "econd edition!7ocket )ooksC 4ew /ork, p.9 Blxxv Warlow, 6. et al *++B!, +troke Practical management Third edition!, )lackwell7ublishingC :xford, p.;B&lxxvi 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. *lxxvii 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. **lxxviii 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. **lxxix 4ational Institute of 4eurological 5isorders and "troke, ./. + entral Pain +yndrome/nformation Page Han *+ !httpC==www.ninds.nih.gov=disorders=centralNpain=centralNpain.htm accessed 2th Huly*+ *!lxxx "cottish Intercollegiate ., 7an(u, A., /ashpal, @. *++&!6entral 4europathic 7ainC 3ocus on 7ost#stroke 7ain. IA"7 7ress "eattle p.* F#**B.lxxxiii 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, p. *Blxxxiv 8udd, A. et al *++2 reprint!, +troke at your Fingertips "econd edition!, 6lass7ublishingC >ondon, 7 *B.lxxxv Warlow, 6. et al *++B!, +troke Practical management Third edition!, )lackwell7ublishingC :xford, p.;F+lxxxvi

7rofessor Anthony 8udd. ?xpert Advisory 7anel. *&th Huly *++F!. Painful, s!ollenhand . (anine.bennett stroke.org.uk
http://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.sign.ac.uk/guidelines/fulltext/118/index.htmlmailto:[email protected]://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.ninds.nih.gov/disorders/central_pain/central_pain.htmhttp://www.sign.ac.uk/guidelines/fulltext/118/index.htmlmailto:[email protected]


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cix )ritish 7ain "ociety, Pain management Programmes for $dults *++&!httpC==www.britishpainsociety.org=bookNpmpNpatients.pdf accessed 2th Huly *+ *!cx )ritish 7ain "ociety, Pain management Programmes for $dults *++&!httpC==www.britishpainsociety.org=bookNpmpNpatients.pdf accessed 2th Huly *+ *!
http://www.britishpainsociety.org/book_pmp_patients.pdfhttp://www.britishpainsociety.org/book_pmp_patients.pdfhttp://www.britishpainsociety.org/book_pmp_patients.pdfhttp://www.britishpainsociety.org/book_pmp_patients.pdf

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F30 Pain After Stroke - Referenced_0