Management of Post-Stroke Spasticity and Pain

Understanding Post-Stroke Spasticity and Pain

Spasticity is defined as velocity-dependent hyperactivity of tonic stretch reflexes and is one of the most important impairments for patients after stroke, causing significant pain and functional disturbances 1
If left untreated, spasticity can lead to contractures, rendering the affected limb functionless and causing hygiene problems 1
Post-stroke pain significantly impacts activities of daily living, sleep quality, and overall quality of life 2

Clinical guidelines for stroke rehabilitation do not include methocarbamol in their recommendations for spasticity management 1, 3, 4
Guidelines recommend a stepwise approach to treating spasticity, beginning with the least-invasive modalities and progressing to more invasive options 1
For spasticity resulting in pain, poor skin hygiene, or decreased function, consider tizanidine, dantrolene, or oral baclofen 3
Avoid diazepam or other benzodiazepines during stroke recovery due to possible deleterious effects on recovery and sedation side effects 1, 3
For selected patients with disabling or painful spasticity, consider botulinum toxin or phenol/alcohol injections, intrathecal baclofen, or neurosurgical procedures 3

Antispastic positioning, range of motion exercises, stretching, splinting, and serial casting are recommended first-line treatments 3, 5
For central post-stroke pain, an individualized patient-centered approach implemented by an interdisciplinary team is recommended 5
Pharmacotherapy should be combined with therapeutic exercise and psychosocial support 5

There is limited evidence from controlled trials of spasticity treatment specifically in stroke patients 1