From the Guidelines
The prevalence of neuropathic pain after stroke is estimated to be around 7% to 8%, with central poststroke pain being the most common form, typically beginning within a few days after stroke. This condition can significantly impact the quality of life, sleep, and rehabilitation outcomes of stroke survivors. According to 1, the incidence of central poststroke pain is estimated at 7% to 8%, and it typically begins within a few days after stroke, with the majority of patients becoming symptomatic within the first month.
The diagnosis of central poststroke pain should be based on established diagnostic criteria, such as those proposed by Klit et al, after other causes of pain have been excluded, as recommended in 2. The choice of pharmacological agent for the treatment of central poststroke pain should be individualized to the patient’s needs and response to therapy and any side effects. Amitriptyline and lamotrigine are reasonable first-line pharmacological treatments, as stated in 2.
Some key points to consider in the management of central poststroke pain include:
- The use of diagnostic criteria for central poststroke pain, such as those proposed by Klit et al, can be helpful in diagnosis.
- Pharmacotherapy combined with therapeutic exercise and psychosocial support is a reasonable approach, as stated in 1.
- Response to treatment is best assessed with standardized serial measurements, such as pain diaries, visual analog scales, or pain questionnaires, as recommended in 2.
- Other options for central pain management include carbamazepine and phenytoin, but their usefulness is not well established, as noted in 1.
- Motor cortex stimulation may be an option for intractable central poststroke pain, as stated in 2.
Overall, the management of central poststroke pain requires a comprehensive approach, including pharmacotherapy, therapeutic exercise, and psychosocial support, with careful assessment and monitoring of response to treatment, as recommended in 1 and 2.
From the Research
Prevalence of Neuropathic Pain
- The prevalence of neuropathic pain in the general population is estimated to be between 6.9% and 10% 3.
- A systematic review of epidemiological studies found that the prevalence of chronic pain with neuropathic characteristics ranged from 3-17% 3.
- The prevalence of neuropathic pain associated with specific conditions, such as postherpetic neuralgia, trigeminal neuralgia, and painful diabetic peripheral neuropathy, varied widely 3.
Neuropathic Pain after Stroke
- There is limited information available on the prevalence of neuropathic pain specifically after stroke.
- However, it is known that neuropathic pain can arise as a consequence of a lesion or disease affecting the somatosensory system, which can include stroke 4.
- The treatment of neuropathic pain, including after stroke, typically involves the use of antidepressants, anticonvulsants, and other medications 4, 5, 6, 7.
Treatment of Neuropathic Pain
- The recommended pharmacotherapy for neuropathic pain includes the use of tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, gabapentin, and pregabalin 4, 5, 6, 7.
- Other treatments, such as lidocaine plasters, capsaicin high concentration patches, and botulinum toxin A, may also be used for specific types of neuropathic pain 6, 7.
- Strong opioids may be considered as a third-line treatment for neuropathic pain when other options have failed 6, 7.