The word ‘stroke’ is the term used when the blood supply to the brain is cut off and the brain does not receive the oxygen it needs and the result is damage to the brain cells. Unlike other cells in the body, brain cells do not regenerate and so the body functions controlled by the damaged brain cells are affected.

There are three main causes of stroke:

• Cerebral Thrombus – a blood clot which forms in a brain artery, blocking the flow of blood to the brain.
• Cerebral Embolus – a blood clot or an air bubble or fat globule which is formed in one part of the circulating blood and which travels to a brain artery, lodging there and cutting off the supply of blood.
• Cerebral Haemorrhage – the rupturing of a brain artery, resulting in bleeding into the surrounding area of the brain.

Those are at risk of getting a stroke
The chance of a stroke increases with age and the majority of strokes happen to people over 65, but a quarter occur in younger patients. Stroke occasionally happens in childhood.

There are, however, a number of major factors, which increase the risk:

• high blood pressure;
• smoking;
• physical inactivity, poor diet and obesity;
• diabetes;
• excessive alcohol intake;
• past history of transient ischaemic attack (TIA or ‘mini-stroke’);
• past history of an irregular heart beat or cardiovascular disease such as a heart attack.

Medical treatment
Medication is available that helps reduce the chance of having a stroke. This includes a daily dose of aspirin. In people at high risk of a stroke or who have already had a stroke, dipyridamole may be added to the aspirin. Clopidogrel may be given as an alternative in patients who have already had a stroke, myocardial infarction or transient ischaemic attack In healthy individuals aspirin can cause bleeding and may be more harmful than beneficial.

People who have raised cholesterol or lipids in their blood should either change their diet or take tablets to reduce these levels. People with irregular heart beats, (“atrial fibrillation”), should be on warfarin to reduce the chance of having a stroke.

Most of them have a greater or lesser degree of loss of movement, which in most cases, happily, improves over time. Some stroke patients may also suffer from numbness and/or tingling in the affected area of the body.

The causes of pain after stroke
Essentially, there are two major causes of pain following a stroke. One is due to the immobility that occurs following a stroke. The second is due to a problem known as central post-stroke pain. Examples of pains that follow a stroke as a result of disability are frozen joints, particularly the shoulder and muscular pains due to the spasms that may occur.

Frozen shoulder
The commonest pain following stroke is “frozen shoulder”. This is a pain which is felt in the shoulder when the joint is moved, and sometimes even when lying on it. It is due to inability to move the joint freely by voluntary means, so that the tissues gum up and the joint becomes “frozen”.

If you are truing to minimise the pain, you may prevent your joint moving too much. In fact, you should ensure that your joint moves through its entire range of movements at least twice a day, (perhaps with the help of a relative or friend). The movements will have been shown to you by a physiotherapist soon after the acute stroke, before any freezing sets in.

If the shoulder becomes frozen despite everything, your doctor can send you to a pain clinic or other specialist service in a hospital where the shoulder can be injected which frees the gummed up tissues so that movement therapy can recommence.

These include treatments aimed at the muscles such as acupuncture and the use of a transcutaneous nerve stimulator. Care with a transcutaneous nerve stimulator should be undertaken if there is numbness. An injection just above the shoulder blade (suprascapular nerve block) can also be helpful in reducing the muscle spasm and alleviating frozen shoulder.

Related Articles:

1. Redu­cing the risk of stroke
2. Rela­tion­ships and com­mu­nic­a­tion prob­lems fol­low­ing a stroke
3. Reduce the risk of high blood pres­sure and stroke
4. Stroke “crisis” in Europe, health experts warn!
5. High blood pres­sure (hyper­ten­sion)- who’s at risk?
6. Treat­ing high blood pres­sure (hyper­ten­sion) 
7. Loneli­ness and high blood pres­sure
8. Keep­ing your blood pres­sure healthy

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