Central Post-Stroke Pain: Evidence-Based Rehabilitation Strategies for Neuropathic Pain Management
DOI:
https://doi.org/10.33096/egfkfz70Keywords:
Exercise therapy, pain, transcranial magnetic stimulationAbstract
Introduction: Central Post-Stroke Pain (CPSP) is a common and challenging condition that affects 8-10% of stroke survivors, significantly impacting their quality of life and functional recovery. Despite its prevalence, effective management remains complex and multifaceted.
Contents: This review explores rehabilitation strategies for CPSP, emphasizing the role of both pharmacological and non-pharmacological interventions. Exercise therapy, including strength training, aerobic conditioning, and flexibility exercises, plays a pivotal role in alleviating pain, enhancing neural plasticity, and improving functional outcomes. Additionally, physical modalities such as transcranial magnetic stimulation (rTMS) and acupuncture, along with psychological approaches like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), address the emotional and cognitive components of CPSP.
Conclusion: A multidisciplinary, patient-centered approach integrating exercise, physical modalities, and psychosocial support is essential for optimizing CPSP management. Further research is needed to refine and standardize rehabilitation protocols to achieve long-term pain relief and improved recovery outcomes for stroke survivors.
References
Klit, H., Finnerup, N. B. & Jensen, T. S. Central post-stroke pain: clinical characteristics, pathophysiology, and management. The Lancet Neurology vol. 8 857–868 Preprint at https://doi.org/10.1016/S1474-4422(09)70176-0 (2009).
2. Yam, M. et al. General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation. Int J Mol Sci 19, 2164 (2018).
3. Khalid, S. & Tubbs, R. S. Neuroanatomy and Neuropsychology of Pain. Cureus 9, e1754 (2017).
4. McEntire, D. M. et al. Pain transduction: a pharmacologic perspective. Expert Rev Clin Pharmacol 9, 1069–1080 (2016).
5. Vadivelu, N., Whitney, C. J. & Sinatra, R. S. Pain Pathways and Acute Pain Processing. in Acute Pain Management 3–20 (Cambridge University Press, 2009). doi:10.1017/CBO9780511576706.003.
6. Cambier, J. [Dejerine-Roussy syndrome]. Rev Neurol (Paris) 138, 979–88 (1982).
7. Head, H. & Holmes, G. Sensory Disturbances From Cerebral Lesion. Brain 34, 102–254 (1911).
8. Treede, R.-D. et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70, 1630–5 (2008).
9. Kim, J. S. Central post-stroke pain or paresthesia in lenticulo-capsular hemorrhages. Neurology 61, 679–682 (2003).
10. Widerström-Noga, E., Loeser, J. D., Jensen, T. S. & Finnerup, N. B. AAPT Diagnostic Criteria for Central Neuropathic Pain. J Pain 18, 1417–1426 (2017).
11. Westerlind, E., Singh, R., Persson, H. C. & Sunnerhagen, K. S. Experienced pain after stroke: a cross-sectional 5-year follow-up study. BMC Neurol 20, 4 (2020).
12. Kim, J. S. Post-stroke pain. Expert Review of Neurotherapeutics vol. 9 711–721 Preprint at https://doi.org/10.1586/ern.09.19 (2009).
13. Bogousslavsky, J., Regli, F. & Uske, A. Thalamic infarcts. Neurology 38, 837–837 (1988).
14. (Bud) Craig, A. D. A new version of the thalamic disinhibition hypothesis of central pain. Pain Forum 7, 1–14 (1998).
15. Bashir, A. H., Abdullahi, A., Abba, M. A. & Mukhtar, N. B. Central Poststroke Pain: Its Profile among Stroke Survivors in Kano, Nigeria. Behavioural neurology 2017, 9318597 (2017).
16. Kumar, B., Kalita, J., Kumar, G. & Misra, U. K. Central poststroke pain: A review of pathophysiology and treatment. Anesth Analg 108, 1645–1657 (2009).
17. Mohanan, A. T. et al. Stroke-Induced Central Pain: Overview of the Mechanisms, Management, and Emerging Targets of Central Post-Stroke Pain. Pharmaceuticals vol. 16 Preprint at https://doi.org/10.3390/ph16081103 (2023).
18. Zhang, Y.-H. et al. Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus. Front Med (Lausanne) 8, (2021).
19. Kim, Y. et al. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease. Am J Phys Med Rehabil 98, 613–621 (2019).
20. Han, P. et al. Clinical Evidence of Exercise Benefits for Stroke. in 131–151 (2017). doi:10.1007/978-981-10-4304-8_9.
21. Vahlberg, B., Lindmark, B., Zetterberg, L., Hellström, K. & Cederholm, T. Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial. Disabil Rehabil 39, 1207–1214 (2017).
22. Ma, Y., Luo, J. & Wang, X.-Q. The effect and mechanism of exercise for post-stroke pain. Front Mol Neurosci 15, (2022).
23. Öte Karaca, Ş., Demirsoy, N. & Günendi, Z. Effects of aerobic exercise on pain sensitivity, heart rate recovery, and health-related quality of life in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research 40, 164–170 (2017).
24. Schmid, A. A., Miller, K. K., Van Puymbroeck, M. & DeBaun-Sprague, E. Yoga leads to multiple physical improvements after stroke, a pilot study. Complement Ther Med 22, 994–1000 (2014).
25. Bastille, J. V & Gill-Body, K. M. A Yoga-Based Exercise Program for People With Chronic Poststroke Hemiparesis. Phys Ther 84, 33–48 (2004).
26. Ramachandran, V. S. & Altschuler, E. L. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain 132, 1693–1710 (2009).
27. Hosomi, K. et al. Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: A randomized, multicenter, double-blind, crossover, sham-controlled trial. Pain 154, 1065–1072 (2013).
28. Bae, S. H., Kim, G. Do & Kim, K. Y. Analgesic effect of transcranial direct current stimulation on central post-stroke pain. Tohoku Journal of Experimental Medicine 234, 189–195 (2014).
29. Katayama, Y., Tsubokawa, T. & Yamamoto, T. Chronic Motor Cortex Stimulation for Central Deafferentation Pain: Experience with Bulbar Pain Secondary to Wallenberg Syndrome. Stereotact Funct Neurosurg 62, 295–299 (1994).
30. Keefe, F. J., Porter, L., Somers, T., Shelby, R. & Wren, A. V. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111, 89–94 (2013).
31. Harrison, R. A. & Field, T. S. Post stroke pain: Identification, assessment, and therapy. Cerebrovascular Diseases vol. 39 190–201 Preprint at https://doi.org/10.1159/000375397 (2015).
