Post-stroke pain

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 (contd)
• 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 (contd)
• 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 survivors 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 helpTreat 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
• 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 (contd)

• 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
  survivors pain.
• Survivors whose pain is being treated may still
  experience pain

28
29
How you can help (contd)

• Discuss the survivors 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