Central post-stroke pain

Pain after stroke is common, occurring in up to half of all people who have had a stroke.

Different types of pain are experienced after a stroke. These include shoulder pain, muscle tightness or stiffness, headache and central post-stroke pain (CPSP), which is a form of nerve pain. Some people get more than one type of pain at a time.

It is important that pain after stroke is recognised and managed early, as it can affect your quality of life. It can cause disturbed sleep and tiredness, affect mood and social functioning and lead to depression and anxiety. Tell the nurse or doctor who is in charge of your care if you are in any pain.

What is central post-stroke pain?

Central post-stroke pain (CPSP) is a form of nerve pain (or neuropathic pain) that occurs in about 1 in 10 people after a stroke.

CPSP can start at the same time as the stroke, but in most people it starts a few weeks or months after their stroke.

CPSP usually occurs in the areas of your body that have been affected by stroke. It can come on suddenly without reason or in response to a stimulus such as stress, touch, movement or temperature. In some people there can be a loss of feeling, whilst in others pain is disproportionate to the stimulus.

People often describe the pain as:

  • Shooting
  • Burning
  • Stabbing
  • Throbbing
  • Numbness (loss of feeling)
  • Pins and needles

These sensations can be mild, moderate or severe and can vary in frequency; some people experience constant pain while others are only affected occasionally. Anxiety, depression and emotion can make CPSP worse.

How is central post-stroke pain managed?

Because CPSP is a nerve pain, standard pain relief such as paracetamol or ibuprofen is often not effective. However, there are different groups of medicines that can be tried, although the evidence that they work is not very strong. You may need to try different ones to find one that works best for you with fewest side effects. You may need a combination of medicines to get the right balance between pain relief and side effects.

Because pain is often associated with depression, sleep disturbances and anxiety, ‘talking’ treatments such as cognitive behavioural therapy can also be useful.

If your pain continues despite initial treatment, your doctor may refer you to a pain clinic for more specialist advice about managing your CPSP.

There are a number of things you can do to help you cope with your pain including relaxation techniques, changing your body position and avoiding things that worsen pain.

See the CHSS factsheet on Central post-stroke pain (PDF) for more information about CPSP.