Many people are all too familiar with the brain damage caused by a stroke. A blood clot or a bleed can quickly kill brain cells and leave a person with many disabilities. Some of the afflictions are easy to observe and some of the afflictions are silently present. Most people notice the paralysis and difficulty communicating. But because communication can be difficult, people may not be aware that nearly 40% of those who have had a stroke will have a new onset of pain as a result.1 And of those who have just had a stroke, many already have been living with chronic pain before the stroke even occurred. Ultimately, chronic pain silently afflicts people after they had a stroke as they lie in the hospital bed, as they sit in an easy chair or as they stare out a window. Some of the sources of pain are easy to understand and some not so easy to equate, but all create the potential for endless days of suffering while in pain.
As one can imagine, headaches are very likely to exist after the brain has been damaged. Chronic migraines frequently occur after a stroke.2 Another likely source of pain is the preexisting conditions like osteoarthritis because the elderly who are at higher risk of strokes are also living with arthritis. Although these sources of pain are intuitively obvious, they are often forgotten when something as dramatic a slurred speech and paralysis are occurring. Beneath the drama lie the other more sinister problems silently causing pain.
Beyond the obvious sources of pain are the mysterious, lesser-known ones that many are feeling every day. After the central nervous system has been damage, the messages get a little scrambled (or a lot scrambled in some cases). As a result, faulty messages might be sent to the muscle system. These messages gone haywire can cause muscle hypertonicity and spasticity which is especially evident in the hands and feet that can claw into a painful vise-like grip. Sometimes the messages to the muscle system are cut off and people experience a lack of muscle tone or paralysis. When the upper limb goes limp, shoulder pain is commonly felt. Muscle weakness was once thought to be the source of a painful shoulder; now, researchers are unraveling the mystery of hemiplegic shoulder pain to unveil a deeper source of pain that lies within the nervous system.3,4 Pain originating in the sensitized nervous system is not only thought to cause shoulder pain but also a wide-spread condition known as central post-stroke pain. With post-stroke pain, burning and sensitivity can be felt in the entire area corresponding to the areas in the brain that were damaged.5 Unfortunately, these mysterious pains are felt, but not necessarily heard or seen.
Finding the words to tell someone that you are in pain is difficult at best. But when the communication centers in the brain are malfunctioning, pain is silently endured. Tools like the Faces Pain Scale might help caregivers assess whether or not a stroke patient is feeling pain. But these tools are often not used at home by friends or family members. These people might not even realize that chronic pain is commonly felt after a stroke and is hard to notice unless you are looking for it. Slight grimaces or rapid, swallow breathing might be the only clues that one is experiencing a headache, shoulder pain or worse. Look for pain in the faces of those who have had a stroke, you’ll find it there silently lurking beneath the stare.