Brendon Haslam talks about pain after stroke

In our most recent podcast and online chat, we spoke to physiotherapist and researcher Brendon Haslam about pain after stroke.

Here we’ve compiled some of his responses to our questions in the podcast, as well as some extra questions about his research and how to get involved.

What’s the relationship between pain and people’s mood?

There's definitely a relationship there. It’s really well detailed actually that there's a strong association with low mood and ongoing chronic pain generally, outside of the stroke population. Whether one causes the other, it can work both ways. What we do know is that having chronic pain is not good. It's not fun and therefore it's quite reasonable that people would go on to, in some cases, experience depression. Also, we know that those with depression have a higher likelihood of developing ongoing pain.

I think one of the big things to understand with regards to low mood is that the chemical balance in the brain starts to change from a release of endorphins or 'happy hormones', or things like that. They are produced when people are actively engaged in meaningful activities and particularly in enjoyable activities. If that is reduced, then that chemical balance starts to change. But also, that chemical balance is really important as a way of quietening down some of the information that's coming in from the body.

In low mood states we tend to lose that ability to quieten down some of the information. Information coming in from the body is perceived as more threatening, so we really need to engage meaningful activities.

What sort of things can people do about chronic pain?

It needs to be holistic. First of all, we need to assess to make sure that there hasn't actually been tissue damage. Stroke survivors, like any of us, can suffer injuries and sprained ankles and various things, so we still need to look at that to exclude that that hasn't happened.

Then it is about assessing what's going on and what are the different contributions to it. From a treatment perspective we look to educate someone; develop an understanding of what triggers the pain, what is more comfortable and look at the psychological component. Engaging in tasks like meditation, mindfulness, yoga, and meaningful physical activities get the system primed to be able to take on more, and help with mood and some of this production of other hormones.

There are also some specific physical strategies that we can look at, and the idea of the sensory information being processed slightly differently. What we're seeing is that in some medication studies that are going on in Europe, the better the sensory system is, the more effective some of the medications are.

From there we can tailor things.

What do you think health professionals need to know about pain?

When we're looking at being effective therapists and health professionals engaging in the area of pain, the most important thing that we can do to start with is educate about what is going on. The more that it is a mystery, the scarier it is and the more unknown. When we feel like we lack control, we lack the potential to have control.

The fundamental thing that is coming through in lots of different groups with chronic pain is the most effective thing is education first. Because people understand what they're trying to do and why we are seeing improved outcomes.

Also, a real priority is educating health professionals—allied health, medical, nursing, across the board—with regards to pain in neurological conditions such as stroke.

Hopefully we're seeing an end to the days of, "You've got pain and you've had a stroke, deal with it." That's no longer a good enough answer now, we need to be better and we need to be able to provide advice and offer strategies.

How did your own research come about?

This study really came about through a frustration at the lack of research regarding pain following stroke. There’s so much published evidence of what a huge problem it is, but so little about what we can do about it. There have been huge advances in scientific knowledge on pain in the last 10–15 years, but it wasn’t coming into the stroke field. I got together with some key researchers from the pain field and the stroke field, to come up with a key study to bring all the understanding together.

What are you hoping to achieve with it?

We’re looking to identify and understand several key contributions to pain following stroke, in particular shoulder, arm and hand pain. By doing this, we will be able to develop treatments targeting pain in stroke and ideally identify which treatments best suit which person and even who is at risk of developing pain.

What will people who take part have to do?

We need people with and without pain to participate—and lots of them!

To participate, visit http://research.noigroup.com/?_p=stls. From there you can give consent and participate anonymously. It involves answering some questions about your stroke and pain if you have it. Then it has some interesting tasks about your ability to recognise different images of body parts—it sounds weird, but it’s actually been a key thing in developing pain treatments recently for other groups.

On average it takes about 15–20 minutes. We’ve had more than 300 stroke survivors participate but we really want 1000.

What are some other pain studies you’re aware of, and how can people find out about them?

Most of the pain studies in stroke are currently being done in Europe and largely involve medications. There is a study being developed in Italy that will look at imagery treatments that will be fascinating, their pilot study results have just been published which showed encouraging results. Also, some recent studies using electrical stimulation have shown some good results. Some studies in Australia are looking at pain as a measure but not necessarily targeting it specifically.

To my knowledge, this is the main Australian study targeting pain specifically. We are anticipating that on completion of this study, a number of new ones looking at treatments will commence based on our results.