Transcript

SECTION 4Post-stroke pain

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Post-stroke pain

► Defining pain► Facts about post-stroke pain ► Types of pain in stroke survivors► Identifying pain in stroke survivors ► Pain assessment and pain scales

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Defining pain

Duration

Acute pain - usually short lived.► It comes from an event, such as surgery or

trauma.► If it is not treated properly, it may lead to chronic

pain.

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Defining pain

Duration (cont’d)

Chronic pain - usually lasts more than 3 to 6 months.

► It lasts longer than the time it takes a wound to heal.

► It may cause anxiety, fear, depression and sleeplessness.

► People with chronic pain may become cut off from others.

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Defining pain

Tissue damage leads to a pain that can be sharp, dull, or aching.

Nerve damage can be in either the:► Central nervous system (the brain and spinal

cord)► Peripheral nervous system (the nerves outside

the central

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Key point

Pain is very common in stroke survivors.

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Facts about post-stroke pain

Pain can be present in:► parts of the body with impaired mobility► people with dementia or cognitive impairment► people who are not conscious.

1 in 2 survivors have pain.

7 in 10 have untreated pain.

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Facts about post-stroke pain

If not treated properly, pain:► Causes anxiety, sleep disturbances, memory

problems, depression, impaired posture and reduced appetite

► Interferes with daily activities like going to the bathroom, dressing, and grooming

► Reduces the ability to move around, talk to other people and participate in recreational activities

► Increases irritability and causes people to refuse care

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Types of pain in stroke survivors

Central post-stroke pain - caused by damage to the brain or spinal cord from a stroke.► The survivor may be in constant pain or might find that their pain comes and goes. It feels like burning,

tingling, stabbing, or like acid under the skin. ► Physical activity, a light touch, stress, cold temperature, or a change in the weather can worsen the

pain.

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Types of pain in stroke survivors

Central post-stroke pain (cont’d)

The survivor may complain of pain:► Where there is no visible tissue damage► From a light touch, such as bedding touching the

legs► When pain is unusually severe – for example,

when a person feels extreme pain after bumping their elbow

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Types of pain in stroke survivors

How you can help:► Watch for symptoms that may indicate the stroke

survivor is in pain.► Acknowledge the survivor’s pain.► Report the pain to the appropriate person, so

that a specialized consultation can take place.

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Types of pain in stroke survivors

Hemiplegic shoulder pain - shoulder pain on the side affected by stroke caused by:► Partial dislocation or shoulder subluxation► Muscles that are contracted (spasticity) or limp (flaccidity)► Shoulder or hand syndrome

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Key point

Identifying and treating shoulder pain early is important. Treatment is difficult and may be even more difficult after the pain is established.

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Types of pain in stroke survivorsShoulder subluxation - Low-tone muscles around the

shoulder allow the joint capsule to stretch and the shoulder joint to separate.

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Types of pain in stroke survivors

Shoulder subluxation

How you can help:► Always handle the shoulder carefully. This can

help prevent painful stretching of shoulder muscles and ligaments.

► Support the shoulder joint appropriately when the survivor is walking, standing or sitting.

► If you are not sure about the care strategies, talk to members of the health care team.

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Types of pain in stroke survivorsSpasticity (high tone) - abnormally high muscle tone. It

shortens the muscles and reduces the shoulder joint space

How you can help:Treat the high-tone arm gently. This means:

► Not forcing the arm to move► Applying prescribed splints properly for the correct length

of time► Using proper positioning► If you are not sure about the care strategies, talk to

members of the health care team.

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Types of pain in stroke survivors

Shoulder or hand syndrome - may begin with shoulder pain. The person can develop a stiff, swollen, and painful hand and wrist.

How you can help► Use recommended positioning to protect the

affected arm and hand► Use the prescribed exercises► If you are not sure about the care strategies, talk

to members of the team

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Key point

Failing to support the shoulder joint or pulling on the affected arm during transfers can cause the shoulder to partially dislocate.

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Other shoulder and arm conditions

► Rotator cuff tear► Tendonitis► Shoulder bursitis► Upper arm fracture

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Identifying pain

Stroke survivors may not say they are in pain – but they may express pain:

► Verbally Using pain words: burning, itching, throbbing Making sounds: moans, groans, grunts, cries, Exclamations and cursing: That hurts! Ouch! Stop

that!

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Identifying pain

► Physically Rubbing or massaging the painful area Bracing, holding, or guarding an area, especially

when they move Frequent shifting, restlessness, rocking Impairment of bowel and bladder function

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Identifying pain

► Through facial expressions Frowning Grimacing Wincing

► Through behaviour changes A usually restless survivor is quiet A usually quiet survivor is restless Change in appetite

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Key point

Pain assessment is completely subjective. There is only one person who knows how severe the pain is -- the person feeling it.

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Pain assessment scale

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Key point

Be observant and recognize pain in the stroke survivors you care for. Up to 70% (7 out of 10) residents in long-term care homes have untreated pain.

Pain is inevitable — suffering is optional.

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How you can help

Your knowledge of the individual survivor is an important tool in identifying pain. Ask survivors who report pain for more information:

► Ask yes or no questions► Use simple words to help survivors identify the

problem► Point to areas that may be painful when asking

questions

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How you can help (cont’d)

► Ask about pain during or after movement► Be patient and take time. Stroke survivors may

need more time to explain what they feel► Use a pain assessment scale regularly to track a

survivor’s pain.► Survivors whose pain is being treated may still

experience pain

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How you can help (cont’d)

► Discuss the survivor’s pain and pain management with the team.

► Ensure that pain management strategies and medication are adequate

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Upon reflection

► Can you recall caring for a person in pain? How did you provide support?

► Some strokes affect how survivors communicate. Describe some ways they may indicate they have pain.

► If you find that someone you are caring for is in pain, what should you do? Who would you report it to?

► What strategies would you use to help someone with pain?

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