Can post-stroke leg pain be treated?

2 answers | Last updated: Nov 02, 2016
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 Answers

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.

Community Answers

Mary simpson answered...



A neuropathic pain with various names.....In an effort to get everyone on the same page term we use is  Central Pain Syndrome We will often use "CPS" for short.

Synonyms: Also known as

Central Post-Stroke Syndrome Dejerine-Roussy Syndrome Central Neuropathy Posterior Thalamic Syndrome Retrolenticular Syndrome Thalamic Hyperesthetic Anesthesia Thalamic Pain Syndrome

Central Pain Syndrome is a neurological condition.

24/7 Sensations can affect us all differently, in different places on our bodies, and at different levels of pain and suffering.

Extremely difficult to diagnose. Often sending the patient to many doctors to find one that believes in their suffering. Finding a doctor who is willing to treat and work to find relief for the person that suffers with this savage pain becomes a miracle in the mind of those that suffer.

Causes: Central pain syndrome occurs because of injury to central nervous system... CPS can be caused by stroke, multiple sclerosis, epilepsy, Parkinson´s disease, toxins, tumors and trauma to brain or spinal cord,  any diseases that eventually reach the central nervous system.

Sensations: It can be a steady, sometimes deep burning, aching, cutting, tearing, pressing, lacerating  mixture of pain sensation. Pain may be moderate to severe in intensity.

CPS may be  described  as weird sensations like Burning: "A chemical, not a purely physical burn" , "bone cold",  "wet" sensations, tingling, a "pins and needles", a " ballooning" sensation, throbbing, the feeling of a dental probe on a raw nerve, even metallic.

Intense skin reactions can accompany these symptoms, such as burning, stretching, tightness, itching, or a crawling feeling. CPS can be aggravated by any light touch such as the feel of cloth on skin making dressing an ordeal, as can the touch of a sheet or blanket. The touch of a loved one, may overwhelm the brain with the pain from CPS.

Intestinal reactions Gut pain, stomach  nausea and vomiting can be a part of CPS.

Numbness The hands, feet, head, and trunk can be affected with a numbness that is painful, and does not offer any relief, only adding to the pain.

Onset CPS  can begin from day one of the stroke/injury or can take months, even years to make it's appearance.  Central Pain Syndrome can be a life threatening condition: It can often cause depression, anxiety, anger, frustration and hopelessness.. When a person rates the pain as a 9 or 10 on a pain scale, and there seems to be no relief in sight, with no hope or understanding or support from family and professionals, they may even come to feel that suicide is the only way out.

Triggers and Sensitivity reactions Stress, anger, depression. Movement, daily activity, ROM exercising, tiredness. Exposure to sun, rain, cold, snow, breezes, AC, drafts, unseen sun flare activity, barometer changes. Environments of warmer and cooler from the particular person´s comfort zone. Added pain or swelling. Light touches of another person, blanket, clothes, splints. Sudden movements: Yawning and other reflexive involuntary movements such as sneezing, being startled, loud noises, bright lights and even vibrations as from riding in a car.

Light sensitivity for the eyes, noise sensitivity for the ears can be  triggers for higher pain levels.

7 Types of pain sensations

Any or all of these pain types can overlap. A person could have one or all of these that can come and go as time passes.

  1. Burning dysesthesia: A mixture of pain sensations in which persistent light touch is perceived as a thermal sensation. There are four overlapping subtypes.

Burning: "A chemical, not a purely physical burn"; "A mentholated burning"; burning it up with fire and acid".

Cold: "Like touching dry ice"; "bone" cold.

Wet:   Wet and uncomfortable underneath the burning."

Motor or Kinesthetic Dysesthesia: A feeling of cramping and contraction associated with burning. "A terrible fatigue in my muscles, "A feeling of drawing, pulling, crushing."

  1. Hyperpathia: Heightened response to a noxious stimulus.

  2. Allodynia: Pain from a very mild stimulus. Can also describe referred pain. Can relate to touch, location, temperature or muscle loading.

Touch: "Light touch from clothing becomes unbearable after a few minutes, like an awful sunburn"; "Paper laid on the legs begins to burn unbearably after a minute or so."

Location: Touching the face might show up as burning on the outside of the forearm. Sitting long enough for the skin to burn can become  burning out to the side on the legs and behind."

Thermal: Picking up a warm drink, it feels hot in the hand. Warm ambient temperature sensitizes the skin so that all the other pain features appear more easily."

Muscle loading: Movement makes the body unbearably sore. The day after exercise, the body might have  awful feelings of lactic acid buildup. Lying in bed can feel like sleeping on rocks.

  1. Shooting or 5. Lacerating: Sharp stabbing pains with an electrical quality.

  2. Circulatory: A very common type in which circulation feels compromised.  The feeling of pins and needles in parts of the body.

  3. Peristaltic: Feeling of fullness,  burning, cramping, nausea or distention.


Central Pain Syndrome can require a multidisciplinary team of pain specialists. Anesthesiologists, neurologists and neurosurgeons, rheumatologists, psychiatrists, physiatrists, family doctors, nurses, physical therapists, acupuncturists, massage therapists, and chiropractors all have different methods of treating chronic pain.