Fran Bailey, eLearning resources manager, Chest Heart & Stroke Scotland
Critical reviewers:
Professor Martin Dennis, University of Edinburgh
Margaret Somerville, Director of Services, Chest Heart & Stroke Scotland
Dr Alastair Cozens, Consultant, NHS Grampian
Can stroke patients use visual analogue scales? Price CIM, Curless RH and Rodgers H. Stroke 1990; 30 : 1357-1361
Reproducibility along a 10 cm vertical visual analogue scale. Dixon JS and Bird HA. Annals of the Rheumatic Diseases 1981; 40 : 87-89
Use of the Faces Pain Scale by left and right handed hemispheric stroke patients. Benaim C, Froger J, Cazoltes C, Gueben D, Porte M, Desnuelle C, Pelissier J. Journal of the International Association for the study of pain. 2007; 128 (1); 52-58
Antiplatelet drug interactions. Mackenzie IS, Coughtrie MWH, MacDonald TM and Wei L. Journal of Internal Medicine 2010; 268 : 516-529
Bob is doing well and although he still has some pain, he feels this is better. He decides to go to the bowling club and gradually starts playing again. The team are very supportive and the following summer they win the championship!
Bev visits Bob. Bob tells her that he is still having problems with pain and she makes a number of suggestions.
She also suggests the following:
Support services: Including counselling, strategies to manage mood, anxiety, anger, frustration, acceptance therapy, coping and positive thinking strategies: Living Life to the Full,self help 4 stroke.
Chronic pain services: These are usually multidisciplinary services including psychology, which use a group or individual approach. Be advised that this may require a medical referral to these services.
Dr Wood explains the various drug treatment options to Bob. At the end of the appointment she calls the stroke nurse Bev to update her and asks her to see Bob and Jean at home the following week. She then writes in Bobs notes.
Consultation notes
I saw Bob today and he has symptoms of Central Post Stroke Pain. I have prescribed amitriptyline at night for him, gradually increasing the dose if he finds the medication helpful; if he does not respond to amitriptyline I will consider changing to lamotrigine. I have explained to Bob that he may not notice any effect from the medication for a week or two and have discussed possible side effects. I have also checked his renal and liver function today in case he does require lamotrigine.
I have updated Bev the stroke nurse about this plan for medication and she plans to see Bob at home next week.
Dr Wood.
More about amitriptyline
Belongs to a group of drugs called tricyclic antidepressants
Commonly used is neuropathic pain management
Common side effects include: dry mouth. dizziness, tiredness, increased appetite and urinary retention
More about lamotrigine
Belongs to a group of drugs called anticonvulsants
Prior to commencing the drug the patient’s renal and liver functions must be checked and these then monitored whilst taking the drug
Common side effects include: nausea/vomiting, irritability, headache, dizziness, diarrhoea
See the Additional Information box below for further information on the pharmacological management of CPSP.
Bob is doing well and although he still has some pain, he feels this is better. He decides to go to the bowling club and gradually starts playing again. The team are very supportive and the following summer they win the championship!
