Pain after stroke - mechanisms, clinical manifestations and rehabilitation interventions

Abstract

Introduction. Different painful syndromes and comorbidities can often occur in stroke survivors; thus, pain management remains a strong issue that interferes with the rehabilitation programs and contributes to poor functional outcomes. Painful conditions can be regarded as comorbidities or complications of stroke itself, which makes the rehabilitation more difficult. The aim of the research was to investigate the types and causes of pain after stroke and the possibilities of rehabilitation interventions for pain control. Methods: A multiple directed literature research was conducted using the key words “stroke”, “pain”, “stroke rehabilitation” and “painful comorbidities” in PubMed, Google scholar databases. Results: The most common types of pain associated with stroke to be found were: shoulder pain, complex regional pain syndrome, central post-stroke pain and headache. Usually, musculoskeletal disorders and pain related to spasticity can lead to chronic suffering, and are related to loss of function. In some cases, different causes of pain can overlap in stroke patients. Discussion: Rehabilitation interventions in stroke can be regarded as a solution or an additional treatment to painful syndromes. Physical therapy methods, movement therapy, heat and cold therapies or TENS can serve as therapeutical and rehabilitation options for shoulder pain, pain related to spasticity or musculoskeletal disorders. A multidisciplinary approach that consists of pharmacological and physical treatments is requested in most of the cases. Conclusion: Post-stroke pain is a common clinical feature, but also a very heterogeneous one, with multiple causes and characteristics. Rehabilitation methods bring new insights and can be regarded as additional instruments for pain treatment in stroke survivors.