Some people experience pain after stroke (PAS). This is a challenging complication for doctors to treat because some pain medications are no longer safe to take after a person has a stroke. Some stroke medications can also interact with certain pain medications.
The medications a doctor will suggest for PAS depend on the cause of the pain, as well as a person’s individual circumstances. People with PAS experience pain for different reasons, each of which requires different medications.
Some causes of post-stroke pain include central pain syndrome (CPS), hemiplegic shoulder pain, and spasticity, or painful involuntary muscle contractions.
Keep reading to learn about the best pain medication for stroke patients.
Doctors typically use antidepressants to reduce the symptoms of mental health conditions, but some of these drugs can also manage pain. The antidepressants capable of doing this include:
- tricyclic antidepressants
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
Previous studies have shown the following antidepressants may help relieve pain:
- amitriptyline (Elavil)
- duloxetine (Cymbalta)
- fluvoxamine
It is worth noting that a previous study found that fluvoxamine only helped if participants began taking the drug within 1 year of the stroke.
Anticonvulsants are drugs that doctors typically use for treating seizures. They may also help with certain types of post-stroke pain, such as CPS.
Gabapentin (Neurontin) and pregabalin (Lyrica) are two anticonvulsants that doctors may prescribe for pain after a stroke. These drugs are calcium channel modulators.
However, there is a lack of clinical trials proving the effectiveness of these drugs. There is some evidence supporting the use of pregabalin, but the studies have produced mixed results. This medication may be more helpful for other symptoms, such as difficulty sleeping, than for pain.
Lamotrigine may also help, but studies supporting this so far are small and limited.
Corticosteroids are anti-inflammatory medications. Doctors may recommend corticosteroid injections for those with PAS due to hemiplegic shoulder pain.
Other things doctors may try for this type of shoulder pain include intramuscular Botox injections or nerve blocks. A systematic review found that, of these two options, Botox injections worked the best. However, the authors stress the need for more studies.
People who develop spasticity after a stroke can benefit from physical therapy to reduce spasms and control pain.
However, some people take medications known as antispasmodics for this type of pain. Some examples include:
- baclofen
- tizanidine (Zanaflex)
- diazepam (Valium)
A 2018 review notes that benzodiazepines, such as diazepam (Valium), are not recommended for managing spasticity. People build tolerance to these drugs quickly and need more to achieve the same effect. Additionally, they may negatively affect motor function in people who have had a stroke.
People who have had a stroke may consider taking over-the-counter (OTC) pain medications for symptoms that are not related to the stroke, such as tension headaches.
It is OK to take OTC acetaminophen (Tylenol) for mild pain that is not due to stroke. However, people should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) wherever possible.
The
If a stroke has affected a person’s cognitive ability, narcotics may also be unsafe. Narcotics cause sedation and
To find out which pain medications to avoid, talk with a doctor or pharmacist.
All of the drugs doctors prescribe for PAS have potential side effects. Some of these drugs can also lead to dependency.
The following table summarizes the possible side effects and risks of some of the drugs a doctor might suggest for PAS:
| Drug | Possible side effects |
| amitriptyline | • dry mouth • constipation • urinary retention • low blood pressure upon standing • fatigue • headaches |
| pregabalin | • fainting • fatigue • difficulty with balance, swallowing, or speaking • tremor • vision problems |
| corticosteroid injection | • pain • bruising • dimpled or paler skin around the injection site • increased appetite • mood changes • difficulty sleeping |
| benzodiazepines | • fatigue • weakness • low blood pressure • dependence • addiction |
| baclofen | • dizziness • weakness • fatigue • psychosis • toxicity to liver |
This is not a comprehensive list of all possible stroke pain medications and their risks. For information about this, please talk with a doctor or pharmacist.
PAS may not fully respond to medication. As such, it can help to combine medication with other approaches, such as:
- Physical therapy: Stretching muscles affected by spasticity can help lengthen muscle fibers and reduce the impact of contractions.
- Splints and braces: These devices can help perform a similar function to stretching, supporting muscles with spasticity and helping with day-to-day function.
- Electrical or magnetic stimulation: There are several therapies that involve applying an electrical current or magnetic stimulation to muscles, or the brain itself, to reduce PAS. These include neuromuscular electrical stimulation (NES) and repetitive transcranial magnetic stimulation (rTMS). NES may help with spasticity, and rTMS may be effective for people with shoulder pain after stroke.
- Surgery: In severe cases, doctors may use surgery to manually lengthen muscles with spasticity.
It is important to discuss all the risks and benefits of post-stroke pain medications with a doctor. Some questions people may want to ask include:
- Which options are available to me?
- Which has the highest chance of helping?
- How quickly will it start working?
- Which medications can I combine safely, if one drug is not enough?
- Should I also receive physical or occupational therapy?
- Which natural remedies can I use for pain?
- How long should I try a pain drug before trying another?
If someone has tried different pain medications and they are not helping, a pain specialist may provide additional support.
The best medication for stroke pain depends on the origin of a person’s pain, their circumstances, and the other drugs they are taking. If a person has CPS, then antidepressants, anticonvulsants, or corticosteroids may help.
For pain due to spasticity,
A doctor can help a person decide what will be best for their needs.