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About Physiatry

Central Poststroke Pain

Condition: Central poststroke pain (CPSP) is a chronic, painful condition that may develop following a stroke in the same part of the body affected by the stroke.

Background: About 8% of stroke patients develop CPSP in the weeks or months after a stroke.  It usually emerges gradually starting within the first month of a stroke, but occasionally it occurs immediately post-stroke. Onset more than 6 months after a stroke is rare.

Risk Factors: Little is known about why some patients develop CPSP while others do not.

History and symptoms: CPSP is typically described as a burning sensation, or sometimes as aching or shooting pains. Patients may have either increased or decreased sensitivity to touch and temperature, especially cold.

Physical Exam: Since many other painful conditions may co-exist in a patient, the first step in diagnosing CPSP is to rule out all other possible causes of pain. There are no clear-cut physical signs that characterize CPSP.

Diagnostic Process: No laboratory tests are available to accurately diagnose CPSP. Imaging studies with MRI or CT may be helpful in pinpointing the damaged areas of the brain that are the source of the pain.  

Rehab Management: Treatment usually involves a combination of drugs and other therapies aimed at reducing but not eliminating symptoms, preserving function, and preventing further complications. Selecting the optimal combination of drugs and other therapies for each patient is determined through trial and error. Drugs may include antidepressants, anticonvulsants, opioid-based pain relievers and anesthetics. Other treatments may include desensitization techniques, relaxation, biofeedback, or one of a number of procedures that stimulate areas of the brain where the pain signals are originating. Treatment plans may need to be periodically re-evaluated and adjusted.

Other Resources for Patients and Families: Family education and involvement in the rehabilitation program can be very beneficial.

For Patients and Families:

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