STROKE: NEW IDEAS, PERSISTING DILEMMAS 

Panminerva Medica 2013 March;55(1):1-10

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

The complexities of pain after stroke - A review with a focus on central post-stroke pain

Seifert C. L. ^{1, 4}, Mallar Chakravarty M. ^{5, 6}, Sprenger T. ^{2, 3} ✉

¹ Department of Neurology, Technische Universität München, Munich, Germany; ² Department of Neurology, University Hospital Basel, Basel, Switzerland; ³ Division of Neuroradiology, University Hospital Basel, Basel, Switzerland; ⁴ Department of Psychiatry, University of Basel, Basel, Switzerland; ⁵ Kimel Family Translational Imaging Genetics Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; ⁶ Department of Psychiatry and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada

Pain is frequently reported following stroke, but seems to be an underemphasized phenomenon since it can importantly impact rehabilitation and long-term outcomes. Two major forms of pain have to be distinguished in patients with post-stroke pain: central, neuropathic pain, arising from the vascular lesion defined as central post-stroke pain (CPSP) and pain primarily triggered by peripheral mechanisms such as hemiplegic shoulder pain and spasticity-related pain. Headache after stroke is difficult to classify since the pathophysiology is unclear. The suggested underlying mechanisms as well as treatment strategies of post-stroke pain differ according to the origin (peripheral versus central). This article aims at reviewing the pertinent evidence regarding clinical characteristics and mechanisms of post-stroke pain generation with a focus on CPSP. We discuss possible treatment options and highlight current pathophysiological concepts.