Understanding Pain After Stroke: Causes, Treatments, and Recovery Tips for Survivors

Pain after stroke is common and can include central post-stroke pain (a type of neuropathic pain), spasticity, shoulder subluxation, and musculoskeletal strain. Causes range from nerve pathway damage in the brain to muscle stiffness and joint misalignment. Pain can slow recovery by limiting movement and participation in therapy.

Treatment options include medications, physical and occupational therapy, botulinum toxin injections, nerve blocks, stretching, proper positioning, gentle exercise, and mind-body techniques. Some survivors also hear about supplements like curcumin. While curcumin has been studied in other conditions, there is no proven benefit for stroke-related pain, and research in this area is very limited. Always consult a healthcare provider before starting any new treatment.

Why Pain Happens After Stroke

A stroke damages brain tissue, disrupting how the nervous system processes sensory information. Depending on the location and severity of the damage, this can lead to different kinds of pain.

One important term to know is neuropathic pain. This means pain that originates from injury or malfunction of the nervous system itself, rather than from damage to muscles, joints, or other body tissues. Neuropathic pain can occur in the peripheral nervous system (nerves outside the brain and spinal cord) or the central nervous system (brain and spinal cord).

In stroke, the damage is in the central nervous system, so when survivors develop ongoing nerve-related pain, it’s called central neuropathic pain. The most common form of this is central post-stroke pain (CPSP).

1. Central Post-Stroke Pain (CPSP) — A Type of Central Neuropathic Pain

What it is: Pain caused by damage to sensory processing areas in the brain, such as the thalamus, after a stroke. How it feels: Burning, tingling, stabbing, or electric shock–like sensations, sometimes triggered by light touch, temperature changes, or even clothing. Why it happens: Stroke-related damage causes nerve pathways to misfire, sending incorrect “pain” messages to the brain even when there is no injury in the limb. Note for survivors: In conversations, you might hear other stroke survivors call this neuropathic pain. They’re referring to this same nerve-origin pain, often describing it as strange, constant, or unusually sensitive to touch.

2. Spasticity-Related Pain

What it is: Muscle stiffness and involuntary spasms from disrupted brain-to-muscle communication. How it feels: Tight, stiff, or cramping muscles, often painful when stretched or moved. Why it happens: Damage to motor control areas creates an imbalance between contraction and relaxation signals, leading to overactive reflexes.

3. Shoulder Subluxation

What it is: Partial dislocation of the shoulder joint in the affected arm. How it feels: Sharp or aching pain in the shoulder, worse with movement or when the arm hangs unsupported. Why it happens: Weak or paralyzed shoulder muscles allow the joint to slip out of alignment. What helps: Early neuromuscular electrical stimulation (NMES) of shoulder muscles can reduce subluxation. Slings and supports help position the arm but work best when combined with active therapy.

4. Musculoskeletal Strain

What it is: Pain from overuse, poor posture, or compensating with the unaffected side. How it feels: Aching or soreness in muscles and joints, sometimes with fatigue. Why it happens: Changes in movement patterns after stroke can overload certain muscles and joints over time.

How Pain Affects Recovery

Post-stroke pain can:

• Limit participation in therapy sessions

• Reduce mobility and flexibility

• Lead to depression, anxiety, and sleep problems

• Increase the risk of muscle loss and joint stiffness

  
  

Addressing pain early is key to maintaining progress in rehabilitation.

Evidence-Based Strategies for Pain Relief

Medical Treatments

• Medications – Anticonvulsants (gabapentin, pregabalin) for nerve pain, and muscle relaxants for spasticity. For CPSP, antidepressants such as amitriptyline or duloxetine have the most consistent evidence.

• Botulinum toxin injections – Reduce spasticity and associated pain.

• Nerve blocks – Temporarily interrupt pain signals.

• Noninvasive brain stimulation – High-frequency repetitive transcranial magnetic stimulation (rTMS) over the motor cortex can reduce central pain in some survivors.

• Physical and occupational therapy – Preserve range of motion, strengthen muscles, and prevent complications like frozen shoulder.

  
  

Self-Management Approaches

• Regular stretching – Keeps muscles flexible and reduces stiffness.

• Proper positioning – Support the affected arm with a sling, pillow, or lap tray to prevent subluxation.

• Gentle exercise – Walking, water exercise, or seated yoga can improve circulation and reduce discomfort.

• Heat and cold therapy – Heat relaxes muscles, cold reduces inflammation.

• Mind-body techniques – Meditation, guided imagery, and breathing exercises can help manage pain perception.

  
  

Practical Tips for Stroke Survivors and Caregivers

• Communicate openly with your healthcare team about pain.

• Keep a pain diary to track triggers and what helps.

• Use adaptive tools and mobility aids to reduce strain.

• Balance activity with rest to avoid overuse injuries.

• Seek emotional support through stroke groups or counseling.

Curcumin and Post-Stroke Pain: What the Evidence Says

Curcumin, the main active ingredient in turmeric, is often marketed as an anti-inflammatory supplement. Some stroke survivors report feeling less pain while taking it, but the scientific evidence does not yet support its use for post-stroke pain.

The problems with curcumin:

• It is unstable in the body and very poorly absorbed.

• No clinical trial has ever shown curcumin to be effective for central post-stroke pain.

• These issues are explained in detail in an article from Science: “Curcumin Will Waste Your Time”. The author summarizes years of research showing that curcumin has never been conclusively effective in any large, randomized, placebo-controlled human trial, despite being tested in dozens of conditions.

  
  

What research exists:

• Animal studies in nerve-injury models suggest possible anti-inflammatory and pain-modulating effects.

• Small human studies in arthritis and musculoskeletal pain have found modest relief, sometimes similar to NSAIDs, but these were not in stroke populations.

• One small trial in people after stroke tested curcumin plus piperine for inflammatory markers, but it did not measure pain and does not support its use.

  
  

Safety cautions:

• “Bioavailable” products often add piperine (from black pepper). Piperine inhibits enzymes like CYP3A4 and transporters such as P-glycoprotein. This can slow the metabolism of many prescription drugs, including anticoagulants, antiepileptics, and certain cardiovascular medications, leading to higher blood levels and potentially increased side effects.

  
  

• Curcumin may increase bleeding risk when combined with stroke medications. Laboratory and case reports show turmeric and curcumin extracts can reduce platelet activity and alter clotting. When combined with aspirin, clopidogrel, warfarin, or newer anticoagulants (DOACs), this may raise the risk of bruising or bleeding.

  
  

• Supplements are not regulated like prescription drugs. In the U.S., dietary supplements do not undergo the same FDA approval process as medications. Independent testing has found contamination, adulteration, or inaccurate labeling in some turmeric/curcumin products. Look for brands tested by independent labs (USP, ConsumerLab, or NSF).

Bottom line: Curcumin is not a proven treatment for post-stroke pain. While it has biological effects in the lab and has been studied in other conditions, the evidence for stroke survivors is currently weak to nonexistent. If you are considering it, discuss risks and interactions with your healthcare provider first.

Share Your Experience

Every stroke survivor’s journey is different, and many people explore a wide range of strategies to manage pain. If you have tried curcumin or turmeric, we’d like to hear how it affected you:

• Did you notice any change in pain or other symptoms?

• Did you experience any side effects or drug interactions?

• How did your healthcare provider advise you?

  
  

We also encourage you to share any other approaches you’ve found helpful, whether medications, therapies, lifestyle changes, or mind-body practices.

Your stories can help other survivors feel less alone and may highlight areas where formal research is still needed. Please remember that shared experiences are not a substitute for medical evidence, and always talk with your healthcare team before starting or stopping any treatment.

Further Resources

• American Stroke Association – Pain After Stroke

• National Institute of Neurological Disorders and Stroke – General Information

• National Institure of Neurological Disorders and Stroke – Central Pain Syndrome