Therapy for Stroke Neuropathy

Central post-stroke pain (CPSP) or thalamic pain syndrome is a type of neuropathy, or nerve pain, that results when part of the central nervous system has been injured. CPSP often develops following a stroke or cerebrovascular accident (CVA).

Presentation

Symptoms of CPSP can develop days or even years after a CVA. Minor symptoms are reported by about half of all stroke patients. Full-blown CPSP is far less common and occurs more often when the right side of the brain is affected. Patients feel pain in arms, legs and trunk on the same side as the stroke or in the face. The pain is experienced as either aching, deep burning, itching, the feeling that the skin is crawling or a pricking, “pins and needles” sensation. Intensity varies widely and can increase or decrease in response to temperature, movement or other physical symptoms. In severe cases, even light touch, such as clothes on skin, can trigger painful reactions. The pain is chronic and pervasive.

Medication

Neuropathy is often treated with prescription drugs. However, most have side effects. Amitriptyline, gabapentin and pregabalin provide the best pain relief with the fewest side effects, but other medications may be used, including anticonvulsants, antidepressants and antiarrhythmics, with varying degrees of success.

CPSP is difficult to treat and often doesn’t respond well to medication. Many patients have to try several types of medications before finding one that is effective. In some severe cases, infusions of lignocaine can bring relief.

Surgery

Several surgical interventions may be tried to treat CPSP, including deep-brain stimulation and motor cortex stimulation. Both have about a 50% success rate. The choice of which of these treatments to try depends on the nature of the underlying CVA damage. Physicians will take MRIs, X-rays or CAT scans to determine the surgical treatment that is likely to offer the best hope of relief of the pain.

Psychological Treatment

Because of the chronic, often debilitating, nature of neuropathic pain, psychological treatment can sometimes be beneficial. For patients with severe unrelieved chronic pain, suicide is a serious risk. Therapy generally focuses on identifying triggers that start or increase the pain. These may include movement, changes in activity levels, exercise, weather changes, stress, anger, sadness or even the touch of a loved one. Even simple things like yawning, a sneeze or the vibration of a moving car can trigger neuropathy. Relaxation techniques, yoga, meditation and hypnosis are sometimes recommended to help the patient cope with the pain.