Related Subjects:
|Analgesia and Pain management
|Sedation and Analgesia on ITU
|Neuropathic Pain Management
|Codeine
|Dihydrocodeine
|Diamorphine
|Morphine
|Paracetamol (Acetaminophen)
Chronic pain can be seen in 30-40% of patients at 6 months after stroke. It can be divided into two basic forms as described below. It can have a huge effect on the quality of life and mood as well as exacerbating depression, anxiety, excessive worry, withdrawal, apathy, and sleep disorder. Stroke Physicians may not always be the best to manage the more chronic and intractable cases and may need to signpost patients according to pain services for ongoing support. There are three different syndromes here though there may be some diagnostic overlap.
This has long been recognised since ancient times and more recently was named as Thalamic pain syndrome of Dejerine-Roussy Syndrome in 1906 who described it as a “severe persistent, paroxysmal, often intolerant pain on the hemiplegic side, not yielding to analgesic treatment". Difficulty in treatment is one of the hallmarks. It has been called “among the most spectacular, distressing, and intractable of pain syndromes”. It is related to strokes involving the thalamus but may be seen in any stroke(s) affecting the spino-thalamo-cortical pathway. Thalamic pain patients usually have lesions mainly in lateral and posterior thalamic nuclei on MRI.
Clinical: Pain tends to come on weeks or months after the initial event and often only comes to note at follow up. There is intense spontaneous or evoked pain in the affected extremities and can affect the entire side of the body with an aching and burning quality. Sensory disturbance is a major component of CPSP, including abnormal temperature sensation, dysesthesia and hypersensitivity to cutaneous stimuli. In contrast, there is often a normal response to light touch and vibration suggesting an issue separate from dorsal columns. Pain appears to be alleviated with relaxation and worsened with emotional and physical stress.
Introduction
Central Post Stroke Pain syndrome (CPSP)
Management
Complex Regional Pain Syndrome
Complex regional Pain syndrome clinical findings (STAMP)
Musculoskeletal Pain Hemiplegic Shoulder Pain
References
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Post Stroke Pain Syndromes
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