Chronic Pain

Post-Stroke Pain & Thalamic Pain

A stroke keeps blood from reaching the brain and leads to brain tissue damage. About 10% of people who experience a stroke eventually develop severe pain that is called post-stroke pain, central pain, or thalamic pain (after the part of the brain typically affected).

The onset and character of this pain is highly variable. It can arise days or years after the stroke, can arise after a major or a minor stroke, and patients describe the pain they feel in many different ways including (but not limited to) burning, aching, and prickling. Many different body parts can be affected, including the face, arm, leg, trunk or even an entire half of the body.

Common characteristics are that the pain is constant (although there is also often an intermittent stabbing component), and is more likely to occur if the stroke occurred in the right side of the brain. The pain usually gets worse over time and can sometimes be aggravated by temperature changes or movement.

Medical Treatment

Medical treatment for post-stroke pain is generally disappointing. The only medications with proven efficacy are tricyclic antidepressants such as amitriptyline (Elavil), which address the constant pain. Relief from the stabbing pain can sometimes be achieved with anti-seizure medications such as gabapentin (Neurontin) and carbamazepine (Tegretol).

Surgical Treatment

With surgical treatment, many patients with post-stroke neuralgia can reduce their pain by 50 percent or more and some patients find excellent or even complete pain relief.

Treatments include:

Which treatment is appropriate for each individual patient depends on a number of variables, including the severity of the stroke and the type of pain the patient is experiencing.

Psychological Treatment


Studies have shown that depression and anxiety make pain worse, yet pain itself can make patients depressed and anxious. To achieve pain relief, it is important that patients break this vicious cycle by seeking treatment from a mental health provider who has experience providing care for patients with chronic pain. 

Resources

Stanford Medicine Resources:

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