Neuroplasticity during that time results in inappropriate
signaling within the pain pathways that results in a
perception of pain that isn’t due to any peripheral cause.
Harvey referred to this as “aberrant neuroplasticity,”
changes to the brain that do not produce a beneficial
outcome. “One of the things that people can misconstrue
about neuroplasticity is that it’s always good, but it’s not
always good,” Harvey said.
And once CPS shows up, in all likelihood it will
continue to be there and will require medical management,
which is typically medications. “Of all the medications we
have available to treat CPS, only about half the patients
treated with medications will have any significant pain
reduction,” Harvey said. “Of those patients who have
significant pain reduction, that pain reduction at best will
be only 50 percent. Once CPS starts, it can be very, very
difficult to treat.”
A helpful resource for survivors with CPS is the
Central Pain Syndrome Foundation.
COMPLEX REGIONAL PAIN SYNDROME
Complex regional pain syndrome (CRPS) is a
phenomenon that happens not only in stroke but can also
happen in peripheral nerve damage. Its symptoms are
extreme neuropathic pain, swelling or inflammation of the
joints and skin, loss of range of motion, eventual atrophy
of the muscle and loss of the hair in the areas involved.
“In stroke patients, it has a tendency to affect the shoulder
and the hand,” Harvey said. “In fact, CPRS for stroke
has also been called shoulder-hand syndrome because it
seems to affect the shoulder and the hand more often than
other regions of the body.”
ADVICE FOR CAREGIVERS
Chronic pain can be stressful for the caregiver
as well as the survivor. It reduces activity and
engagement in life and with others and may
lead to isolation, which tends to increase
caregiver burden. “It’s emotionally stressful to
see your loved one in pain,” Harvey said.
Early on when the survivor is starting to have
pain and the pain is becoming significant,
the caregiver should advocate, be supportive
and do what the doctor says. Encourage the
patient that there’s hope for treatment. “If it
becomes a chronic pain problem, then the
pain becomes a lifestyle and the caregiver
needs to learn how not to reinforce pain
behavior,” Harvey said.
The caregiver must be watchful to not be
manipulated: “I’m having pain so I need
my pills. Give them to me.” Harvey says
caregivers must not respond to those kinds
of things. “You don’t reward pain behavior,”
he said. “You reward behavior where the
person is not letting pain control their life.
But that’s a process most people have to
learn, perhaps through a comprehensive
pain management program.”
Spasticity itself is not typically
painful, though it often foretells
pain syndromes — nearly
three-quarters of survivors with
spasticity developed pain.