Central Post-Stroke Pain

Shao-Lun Tsao, M.D.
Staff Anesthesiologist
Department of Anesthesiology      
Division of Pain Management
Changhua Christian Hospital
135 Nanhsiao St.
Changhua, 500 Tawian

Young Woo Cho, M.D., Ph.D.
Associate Professor
Department of Anesthesiology and Pain Medicine
Ulsan University Hospital
290-3 Cheonha-Dong, Dong-Gu
Ulsan, 682-060, Korea

Billy K. Huh, M.D., Ph.D.
Associate Professor
Department of Anesthesiology
Division of Pain Management
Duke University Medical Center
Durham, NC 

Introduction - TOP

Post-stroke pain (PSP) was first described by Dejerine and Roussy in 1906 as “thalamic syndrome,” but it is well known that PSP is not limited to lesions in the thalamus. PSP can be triggered by injury to other areas of the central nervous system.1  Moreover, incidence of chronic pain following stroke varies widely among literature. The fact that pain is not always associated with stroke, the presence of different types of PSP and the ubiquity of pre-existing chronic pain in this population make diagnosis of PSP challenging. The most common forms of PSP are musculoskeletal pain, central post-stroke pain (CPSP), headache, as well as pain from spasticity.2-3 

CPSP is a central neuropathic pain syndrome that occurs after an ischemic or hemorrhagic stroke and can affect tissue anywhere along the spinothalamic pathway, thalamus, or its cortical projections. It is often overlooked due to the presence of other more prominent neurologic symptoms following a stroke e.g., sensory deficit, inability to move a limb, or, inability to compose or understand speech.  CPSP is not a rare pain syndrome affecting 5-8% of patients after a stroke, but the prevalence varies depending on the location of the lesion. Clinical data have demonstrated that patients with lateral medullary infarction (Wallenberg’s syndrome), or thalamic infarction involving the ventral caudal nucleus are more prone to develop CPSP.4-5

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