What will help with mom's post-stroke pain?

A fellow caregiver asked...

My mother (82) had a massive stroke in July 2010 in the Left Parietal Lobe. Since then she has regained her sight, can move her left side legs and arms and is chewing. She can no longer speak or function in her right side and lost control of her bladder function. Since her stroke she has been suffering from major pain on her right leg and arm. She is on Vicodin and Gabapentin, but this has little affect when trying to get her out of bed. Is there any recommendations for the severity of the pain and how we can get her out of bed without the pain?

Expert Answer

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

Sorry to hear about your situation. I have a few thoughts:

There are typically two types of pain in the extremities that a stroke victim can suffer. The first are "referred pains" that come from the interruption of the normal sensory pathways to the limb. These are often treated with medications such as gabapentin, pregabalin, amitriptyline, or duloxetine. Non-medical treatments would include accupuncture and massage.

The second type of pain comes from muscle spasticity. This is probably best treated with boltulinum toxin injections into the effected muscles. Medications for this also include baclofen, Valium, and Xanaflex, but I find that these are less effective than the injections. Accupuncture, massage, and range of motion exercises can also be very effective for these pains.

I would seek out a Neurologist or, better yet, a Physiatrist (Physical Medicine Physician) to help with these treatments. I would definitely avoid Vicodin and other opiates if at all possible, as these give good short term gains but long term are very harmful, as they lead to opiate induced hyperalgesia - a very terrible condition.

I hope this helps. Good luck.