Central post-stroke pain (CPSP), also known as thalamic pain syndrome , is a chronic pain condition that occurs following an ischemic or hemorrhagic stroke. Pain is associated with abnormal sensation of pain and temperature. Wallenberg first described CPSP in 1895, as a symptom of lateral medullary stroke syndrome, which is also known as Wallenberg syndrome . Dejerine and Roussy then described this condition as a lesion of the thalamus in 1906s. Cassinari and Pagni expanded the definition to included lesions along the spinothalamic pathways in 1969.

Approximately 8% of stroke patients are afflicted with CPSP, with increased risk given to increased age [1].

CPSP can occur in weeks to months after the stroke and falls under the category of neuropathic pain [2]. One hypothesized mechanism includes the result of hyper-irritable surviving cells along the spinothalamic and thalamocortical pathways [3].

Onset of pain can be immediate in 20% of patients with CPSP, 50% within 1 month of acute stroke , and the remaining 30% after 1 month of acute stroke [4]. CPSP can be constant or intermittent. CPSP is associated with the following: mild hemiparesis; hemisensory deficit; hyperpathia, which is pain out of proportion to a mildy noxious stimuli; allodynia, which is perception of pain to non-noxious stimuli; hemiataxia; astereognosis, which is reduced object recognition; movement disorder, which lasts for hours on one side of the body [2]. Pain is described as burning, cold, stabbing, sharp, aching, pricking, squeezing, shooting, tingling, or heavy; it is often triggered by light touch or change in temperature [2].

Severe pain associated with CPSP can impact the performance of activities of daily living (ADLs), thereby impacting the quality of life.

Avoid the use of TENS in individuals with a cardiac pacemaker or defibrillator. Neurosurgical ablative interventions are often complicated by morbidity and mortality, which include onset of dysesthesias, hemiparesis, cognitive impairment, or death.

Few treatment strategies are available to target sensory deficits associated with CPSP.

CPSP is a relatively common chronic pain condition that develops after stroke, which can impact the quality of life of patients. There are few treatment strategies that are evidence based, but could nevertheless potentially abbreviate symptoms if recognized early.

There are many possible causes of post-stroke shoulder pain (PSSP), which include shoulder subluxation , adhesive capsulitis , impingement syndrome , complex regional pain syndrome (CRPS), brachial plexus/peripheral nerve injury , or spasticity . PSSP pain is reported in 62% of stroke survivors [7].

Risk factors associated with PSSP include motor weakness, sensory deficits, range-of-motion deficits, spasticity, and other comorbidities such as diabetes mellitus.