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Central post-stroke pain

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VOL: 102, ISSUE: 20, PAGE NO: 23



- Central post-stroke pain results from damage to the thalamus, which occurs during a stroke.



- The thalamus is responsible for translating impulses from receptors around the body into sensations of pain, temperature and touch.



- Central post-stroke pain may not appear for some time after the initial stroke or, in some cases, until months after. This feature of the pain can mean that sometimes it is not initially associated with the original stroke.



- Approximately 5% of people who have a stroke will experience this type of pain.



- The precise cause of the pain is unknown.



- Because the thalamus is damaged, pain is felt in the area of the body affected by the stroke.



- Symptoms include:



- Burning sensation;



- Aching;



- Stabbing pain;



- In rare cases there can be itching.



- Symptoms will be experienced on the side of the body affected by the stroke. This can include the face, arm, leg and, less commonly, the trunk.



- These sensations can be mild, moderate or severe and can vary in frequency, with some people experiencing constant pain whereas others will be affected intermittently.



- In some cases the affected area will suffer a loss of sensation.



- Some people will find that normally non-painful sensations such as a light touch can become painful.



- Some people may find stress exacerbates symptoms.



- Central post-stroke pain often does not respond to conventional pain treatments such as painkillers but there are both surgical and pharmacological options.



- Drug treatments include:



- A mixture of amitriptyline and gabapentin provides the best results with the fewest side-effects;



- Other medicines that can be used include anticonvulsants, antidepressants and antiarrhythmics;



- IV lignocaine infusions can be efficacious in some patients.



- Surgical options include:



- Deep brain stimulation uses a surgically implanted, battery-operated neurostimulator to electrically stimulate targeted areas of the brain;



- Motor cortex stimulation is a newer procedure. It uses a programmable electronic device to send electric pulses to an electrode attached to the layer covering the brain.



- As with all chronic pain, there is an element of psychology in how individuals perceive the intensity of their pain. It can be helpful for people experiencing central post-stroke pain to visit a healthcare professional specialising in the evaluation and treatment of chronic pain.

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