Dealing with post-stroke nerve pain (and the role physio plays in rehabilitation)

After suffering a stroke, some people can end up with a wide variety of secondary effects.

One such after-effect is nerve pain, or “neuropathy”, the symptoms of which can be frustrating for stroke sufferers, but there are ways to treat it.

The cause and symptoms an individual may experience depends on the type of nerve pain – peripheral or central neuropathy. Let’s unpack them:

Peripheral neuropathy stems from localised nerve damage which was not caused by the stroke, but rather by damage to the nerves outside of the brain and spinal cord. 

• It feels like pain or numbness in one area of the body and typically affects the hands and feet. 
• Causes include a traumatic injury, diabetes and an infection.

Central neuropathy stems from damage to the central nervous system, which includes the brain and spinal cord, from a serious event like a stroke. 

• It is commonly referred to as central post-stroke pain (CPSP) and affects 1-8% of stroke survivors. 
• Unfortunately the evidence for the pathology and treatment of this type of nerve pain after stroke is limited. 
• It is typically characterised by a burning sensation, pins and needles sensation, or intense stabbing or searing pain. 
• It can also increase sensitivity to tactile stimulation, for example a gentle breeze across the skin can feel like razor blades or intense burning.  This pain is chronic and can be present even if the stroke survivor has diminished sensation in those areas of the body.

Delayed onset of pain

Diagnosing central neuropathy after stroke is difficult because it often develops months or even years after stroke. 

This delayed onset of pain can lead to misdiagnosis, and is critical to avoid, as treatment for localised pain does not work for central nerve pain. 

It is recommended to keep notes about your recovery from stroke in a journal and take it to doctors appointments.  Writing down the symptoms and your stroke recovery timeline will help illustrate the problem for a more accurate diagnosis.  

Treatment for both types of neuropathy are different because they have different causes:

Peripheral neuropathy treatment involves – 

• Pain medication – over the counter for mild symptoms and prescription medication for more severe pain
• Anticonvulsant medication – usually used to treat seizures, can help to relieve nerve pain by reducing the “excitability” of nerve cells that send pain signals 
• Topical pain relievers – pain patches and creams applied to the skin can provide temporary pain relief 
• Antidepressant medication – has been shown to help with pain relief

Central neuropathy treatment involves – 

• Anticonvulsant medication
• Antidepressant medication 
• Corticosteroid medication – such as prednisolone to help reduce inflammation
• Physical exercise – The brain has the ability to create and rewire neural pathways (neuroplasticity). A physiotherapist can help you to retrain your brain and make new connections through methods such as motor training and mirror therapy. 
• Electroacupuncture – electrical stimulation applied via acupuncture needles inserted into the body 
• Deep-brain stimulation – an invasive treatment involving placing electrodes deep within the brain to stimulate your central nervous system
• Repetitive transcranial magnetic stimulation involves the use of electrodes to deliver electromagnetic pulses over specific areas of the brain

The role of physio treatment

Physiotherapy is an important part of rehabilitation following a stroke.

At TPC, our physiotherapists can help restore loss of movement, as well as assist you in regaining strength, thus enabling you to remain as independent as possible. They can also help you to relearn movements, coordination skills and balance by using repetitive exercises and techniques that help with brain neuroplasticity.

Importantly, physios can provide the tools to help you manage your neuropathy pain. Some physiotherapists are also trained in electroacupuncture.

Neuropathy can be debilitating and lead to a loss of independence and daily function which can contribute to conditions such as post-stroke depression or feelings of grief after stroke. At TPC, we will work with you to help set up a meaningful goal with a step by step plan so you can stay connected, stay encouraged and continue searching for solutions for neuropathy after stroke.

 

Article written by Karleen Scott, TPC physiotherapist