Can post-stroke leg pain be treated?

Kima asked...

My mother just had a stroke two weeks ago. My question is she had a tightness in her right leg. Therapy and muscle relaxers aren't helping. She says it hurts a lot. She can't sleep or eat very much. Because of the pain in her right leg, she shakes her left one uncontrollably. Is there something her doctor is missing? She has Kaiser Permanente for her medical provider. We would like a second opinion, but we were told we can't go outside Kaiser. Is there something we can do about that? Can we make them pay for an outside doctor?

Expert Answer

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

It is not uncommon to have severe tightness, otherwise known as spasticity, in an affected limb after a stroke. This occurs because of lack of control of the spinal reflexes to the limb.

If standard muscle relaxants and pain killers are not working, I often request a Botox shot be placed into the tight muscles. This loosens them up considerably, and is often extremely helpful. I would ask my internist for a referral to either a Physical Therapy Physician or a Neurologist - whichever one does Botox shots in the Kaiser system. Going out of system may result in paying out of pocket, which could cost thousands. If you insist on going outside of their system, and don't have the money, you could also inquire with a Kaiser Social Worker who could help you through the process of getting an outside-of-network consultation, or at least point you in the direction of someone who can help.

For the pain associated with the tightness, I would consider such medications as amitriptyline, nortriptyline, gabapentin, Lyrica, or Cymbalta. Occasionally, topiramate will also be helpful. Please mention that list to your physician and see if any would be safe in your mother's case.

I hope that helps.