Knowledge Base

Central Post-Stroke Pain

What is Central Post-Stroke Pain?

Central Post-Stroke Pain (CPSP) is neuropathic pain resulting from injury to the central nervous system (the brain, brainstem or spinal cord) as a result from a stroke. The pain may not appear until weeks or months after a stroke, though not all stroke patients develop this condition. 

What are the symptoms?

Patients with CPSP may experience a variety of symptoms which include constant or chronic pain, passing pain that comes and goes, pain described as burning or stabbing, or an itchy sensation. Pain symptoms may be felt along the side of the body where the stroke occurred. In some cases the pain may also be felt on the face, limbs or torso.   

Is there any treatment?

Treatment of CPSP is challenging and many patients do not experience sufficient pain relief. Part of the difficulty in finding sufficient treatment is the results of a lack of complete understanding of the mechanism of CPSP, its causes as well as the co-existing psychological and emotional aspects of chronic pain. 

A combination of different drugs are typically used to manage CPSP which include antidepressants and anticonvulsants. Opioids are sometimes used during a pain crisis, but are generally not recommended for ongoing pain management of CPSP. Electro-magnetic stimulation may also be used to manage CPSP pain in some cases, but is not necessarily widely available and still being evaluated in terms of its effectiveness. 

What is the prognosis?

Rehabilitation after stroke is an ongoing process and complete recovery is not always a achievable goal. Some patients with CPSP experience a reduction in pain over time, but for many it persists as a lifelong condition. Where CPSP persists, chronic pain management strategies can help improve quality of life.

Related evidence

Central post-stroke pain: clinical characteristics, pathophysiology, and management.
Klit H, Finnerup NB, Jensen TS.
Lancet Neurol. 2009 Sep;8(9):857-68. doi: 10.1016/S1474-4422(09)70176-0.
Long-term outcomes of deep brain stimulation for neuropathic pain.
Boccard SG, Pereira EA, Moir L, Aziz TZ, Green AL.
Neurosurgery. 2013 Feb;72(2):221-30; discussion 231. doi: 10.1227/NEU.0b013e31827b97d6.
Pharmacological Management of Central Post-Stroke Pain: A Practical Guide.
Kim JS.
CNS Drugs. 2014 Aug 12. [Epub ahead of print]