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Post-Stroke Pain Syndrome

Lesions at any level of the neuroaxis (generally affecting spinothalamocortical afferent sensory pathways) including the medulla, pons, midbrain, thalamus, subcortical white matter, and the cortex may produce central pain. However, the thalamus and the brainstem are common sites for central post-stroke pain.

Thalamic post-stroke pain syndrome (Dejerine-Roussy syndrome) was first described in 1903. Eight to sixteen percent of thalamic stroke may lead to chronic pain. The frequency of pain after a geniculothalamic artery stroke is relatively higher (13% to 59%). Pain is the cardinal symptom and is described as spontaneous, severe, paroxysmal, and burning. Patients with thalamic pain syndrome also have hyperalgesia and allodynia in the affected limbs. Right-sided lesions predominate among reported cases of the thalamic pain syndrome.

Patients reporting pain due to brainstem infarction usually have involvement of pontine or medullar. Patients with midbrain infarction seldom complain of pain. Transient eye and nose pain may be manifested as an initial symptom of pontine infarction. About 25% patients with dorsolateral medullary infarction develop ipsilateral facial pain, especially when the lesion involves the spinal trigeminal tract. Facial allodynia is also common. Some patients may experience pain in the contralateral limbs and trunk.

Treatment of central post-stroke pain remains a challenge. Tricyclic antidepressants are still a choice of treatment. Gabapentin and lamotrigine have been used to treat central post-stroke pain syndrome in open labeled studies. Selective posterior rhizotomy has been reported to decrease painful spasticity in the lower limbs of hemiplegic patients after a stroke. It has been reported that chronic motor cortex stimulation therapy provides pain relief for some post-stroke patients. Thiamylal- and ketamine-sensitive and morphine-resistant cases may have more long-lasting pain reduction after chronic motor cortex stimulation therapy. Stereotactic radiosurgery of the pituitary has been used to treat thalamic pain syndrome with some success.

Forty to sixty percent of patients may develop shoulder pain after a stroke. The mechanism of shoulder pain is not clear. However, there is a strong association between pain and an abnormal shoulder joint examination, ipsilateral sensory abnormalities and arm weakness. These patients usually have significant tenderness over the shoulder joint. It is postulated that the pain is due to inflammation in the joint, secondary to immobilization and joint contracture (frozen shoulder syndrome). The majority of shoulder pain may be resolved or improved for 6 months following a stroke with intensive physical/occupational therapy. Anti-inflammatory medications may be used. Suprascapular nerve or brachial plexus block can provide temporary pain relief to prepare for physical therapy. Proper positioning of the shoulder, range of motion activities, and avoidance of immobilization may further help prevent or alleviate shoulder pain.

Meet the FLPNR Team

  • Richard Adkins, MD
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Anesthesiology Specialist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Anesthesiology Specialist in Ocala, FL

Richard Adkins, MD

Anesthesiology Specialist

Dr. Richard Adkins has been in practice for more than 30 years. His specialty is in anesthesiology and pain medicine.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Hoang (Wayne) T. Vu is board certified by both the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation. Dr. Vu earned his degree of Doctor of Osteopathic Medicine from Touro University College of Osteopathic Medicine in California in 2003.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.


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