Johns Hopkins Health Alert
CPSP: Chronic Pain After a Stroke
Surviving a stroke often means adapting to physical and emotional changes that can last the rest of your life. Many patients develop chronic pain syndromes after suffering from a stroke. But one type of pain is often undertreated or misdiagnosed: central poststroke pain (CPSP) syndrome.
CPSP, also known as thalamic syndrome or thalamic pain syndrome, is a neurological disorder that develops when the central nervous system -- the brain and spinal cord -- is damaged. It can occur when a stroke injures the thalamus or parietal lobe -- the parts of the brain that process sensory stimuli like heat, cold and touch. As a result, sensory neurons in these areas of the brain misfire, so the brain no longer responds properly and registers all stimuli as pain. This malfunction leads to chronic, and sometimes disabling, pain.
About 8 percent of people who have a stroke develop CPSP, according to a recent review article in Topics in Stroke Rehabilitation, which takes an in-depth look at current CPSP diagnosis and treatment practices.
How does it feel? People who have CPSP sometimes describe the pain as a burning or "pins-and-needles" sensation. The pain can be widespread or focused on a specific body part, such as the hands or feet. Some people experience spontaneous stabbing or searing sensations that can be intolerable. Others feel a loss of sensation in the area affected. Touch, movement, stress and temperature changes can all worsen pain. Patients may also develop a condition called allodynia, which makes the body ultrasensitive to normal touch and other physical contact.
According to a study cited in the review article, roughly two-thirds of patients who developed CPSP first noticed the symptoms within one month after stroke; the remaining patients said their pain didn't begin until six months to a year after their strokes. In some cases, CPSP took up to 18 months after stroke to emerge.
Doctors unfamiliar with CPSP may not at first link new pain to the past stroke because of the time lag before symptoms appear. CPSP symptoms also resemble those of other pain syndromes, and sometimes patients have more than one type of poststroke pain, making it more difficult to achieve an accurate diagnosis. CPSP is often misdiagnosed as a musculoskeletal condition. Getting CPSP under control requires an accurate diagnosis and proper treatment plan.
Posted in Hypertension and Stroke on October 22, 2013
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