1. SECTION 4
Post-stroke pain

2. 2

3. Post-stroke pain Defining pain Facts about post-stroke pain
Types of pain in stroke survivors
Identifying pain in stroke survivors
Pain assessment and pain scales

4. Defining pain Duration Acute pain - usually short lived.
It comes from an event, such as surgery or trauma.
If it is not treated properly, it may lead to chronic pain. 4

5. Defining pain Duration (cont’d)
Chronic pain - usually lasts more than 3 to 6 months.
It lasts longer than the time it takes a wound to heal.
It may cause anxiety, fear, depression and sleeplessness.
People with chronic pain may become cut off from others. 5

6. Defining pain
Tissue damage leads to a pain that can be sharp, dull, or aching.
Nerve damage can be in either the:
Central nervous system (the brain and spinal cord)
Peripheral nervous system (the nerves outside the central 6

7. Key point
Pain is very common in stroke survivors. 7

8. Facts about post-stroke pain
Pain can be present in:
parts of the body with impaired mobility
people with dementia or cognitive impairment
people who are not conscious.
1 in 2 survivors have pain.
7 in 10 have untreated pain. 8

9. Facts about post-stroke pain
If not treated properly, pain:
Causes anxiety, sleep disturbances, memory problems, depression, impaired posture and reduced appetite
Interferes with daily activities like going to the bathroom, dressing, and grooming
Reduces the ability to move around, talk to other people and participate in recreational activities
Increases irritability and causes people to refuse care 9

10. Types of pain in stroke survivors
Central post-stroke pain - caused by damage to the brain or spinal cord from a stroke.
The survivor may be in constant pain or might find that their pain comes and goes. It feels like burning, tingling, stabbing, or like acid under the skin.
Physical activity, a light touch, stress, cold temperature, or a change in the weather can worsen the pain. 10

11. Types of pain in stroke survivors
Central post-stroke pain (cont’d)
The survivor may complain of pain:
Where there is no visible tissue damage
From a light touch, such as bedding touching the legs
When pain is unusually severe – for example, when a person feels extreme pain after bumping their elbow 11

12. Types of pain in stroke survivors
How you can help:
Watch for symptoms that may indicate the stroke survivor is in pain.
Acknowledge the survivor’s pain.
Report the pain to the appropriate person, so that a specialized consultation can take place. 12

13. Types of pain in stroke survivors
Hemiplegic shoulder pain - shoulder pain on the side affected by stroke caused by:
Partial dislocation or shoulder subluxation
Muscles that are contracted (spasticity) or limp (flaccidity)
Shoulder or hand syndrome 13

14. Key point
Identifying and treating shoulder pain early is important. Treatment is difficult and may be even more difficult after the pain is established. 14

15. Types of pain in stroke survivors
Shoulder subluxation - Low-tone muscles around the shoulder allow the joint capsule to stretch and the shoulder joint to separate. 15

16. Types of pain in stroke survivors
Shoulder subluxation
How you can help:
Always handle the shoulder carefully. This can help prevent painful stretching of shoulder muscles and ligaments.
Support the shoulder joint appropriately when the survivor is walking, standing or sitting.
If you are not sure about the care strategies, talk to members of the health care team. 16

17. Types of pain in stroke survivors
Spasticity (high tone) - abnormally high muscle tone. It shortens the muscles and reduces the shoulder joint space
How you can help:Treat the high-tone arm gently. This means:
Not forcing the arm to move
Applying prescribed splints properly for the correct length of time
Using proper positioning
If you are not sure about the care strategies, talk to members of the health care team. 17

18. Types of pain in stroke survivors
Shoulder or hand syndrome - may begin with shoulder pain. The person can develop a stiff, swollen, and painful hand and wrist.
How you can help
Use recommended positioning to protect the affected arm and hand
Use the prescribed exercises
If you are not sure about the care strategies, talk to members of the team 18

19. Key point
Failing to support the shoulder joint or pulling on the affected arm during transfers can cause the shoulder to partially dislocate. 19

20. Other shoulder and arm conditions
Rotator cuff tear
Tendonitis
Shoulder bursitis
Upper arm fracture 20

21. Identifying pain
Stroke survivors may not say they are in pain – but they may express pain:
Verbally
Using pain words: burning, itching, throbbing
Making sounds: moans, groans, grunts, cries,
Exclamations and cursing: That hurts! Ouch! Stop that! 21

22. Identifying pain Physically Rubbing or massaging the painful area
Bracing, holding, or guarding an area, especially when they move
Frequent shifting, restlessness, rocking
Impairment of bowel and bladder function 22

23. Identifying pain Through facial expressions Through behaviour changes
Frowning
Grimacing
Wincing
Through behaviour changes
A usually restless survivor is quiet
A usually quiet survivor is restless
Change in appetite 23

24. Key point
Pain assessment is completely subjective. There is only one person who knows how severe the pain is -- the person feeling it. 24

25. Pain assessment scale 25

26. Key point
Be observant and recognize pain in the stroke survivors you care for. Up to 70% (7 out of 10) residents in long-term care homes have untreated pain. Pain is inevitable — suffering is optional. 26

27. How you can help
Your knowledge of the individual survivor is an important tool in identifying pain. Ask survivors who report pain for more information:
Ask yes or no questions
Use simple words to help survivors identify the problem
Point to areas that may be painful when asking questions 27

28. How you can help (cont’d)
Ask about pain during or after movement
Be patient and take time. Stroke survivors may need more time to explain what they feel
Use a pain assessment scale regularly to track a survivor’s pain.
Survivors whose pain is being treated may still experience pain 28

29. How you can help (cont’d)
Discuss the survivor’s pain and pain management with the team.
Ensure that pain management strategies and medication are adequate 29

30. Upon reflection
Can you recall caring for a person in pain? How did you provide support?
Some strokes affect how survivors communicate. Describe some ways they may indicate they have pain.
If you find that someone you are caring for is in pain, what should you do? Who would you report it to?
What strategies would you use to help someone with pain? 30