Pain after a stroke

Stroke and pain

A stroke happens when the blood supply to part of the brain is cut off, either by a clot or by bleeding. Brain cells in that area are damaged. This can affect movement, feeling, speech, thinking and mood, often on one side of the body.

Stroke is often thought of as something that happens to older people, but around 1 in 4 strokes in the UK happen to people of working age. Around 100,000 people have a stroke each year, and about 1.4 million stroke survivors live in the UK.

Pain is a common problem after a stroke. It may come from damage to the brain itself, from weak or tight muscles, or from joints that don't move as they used to. Pain that lasts more than 3 months is called chronic pain. It can be treated, so it is always worth telling your team about it.

Types of pain after a stroke

You may have more than one type. Each needs a different approach, so it helps to describe your pain carefully to your team.

Central post-stroke pain

Nerve pain caused by damage to the parts of the brain that process feeling. Burning, freezing, shooting or throbbing pain, or pins and needles, usually on the side affected by the stroke. Up to 1 in 5 people may develop it.

Shoulder pain

Very common on the weak side. Weak muscles can't hold the shoulder joint in place, so the arm's weight strains it. Pain may come from a stiff "frozen" shoulder or from the joint partly slipping out of place (subluxation).

Spasticity

Muscles that stay tight or go into spasm, because the nerves controlling them are damaged. It affects around 1 in 4 stroke survivors and can be painful. It can start within a week or develop later.

Contractures

If spasticity isn't treated, muscles and tissues can shorten for good, so a joint can't fully straighten. This can affect dressing, hand use and walking.

Swollen hand

If the hand or arm doesn't move much, fluid can build up. The hand may be puffy, stiff and sore.

Headaches

Some people get new headaches after a stroke. They can be linked to the stroke, to medicines, or to tense neck and shoulder muscles.

Joint and muscle pain

Walking differently, or relying more on the stronger side, can strain the back, hips, knees and the other shoulder.

Fatigue

Not pain, but a very common effect. A deep tiredness that doesn't always lift with rest, and makes pain harder to cope with. NICE says it should be checked at your 6-month review.

When pain starts and how recovery goes

Recovery from a stroke is different for everyone. For some it takes days or weeks; for others it takes months or years. Pain can appear at different points along the way.

First days and weeks

Hospital and stroke unit

Emergency treatment, then rehab starts. Careful positioning and handling of the weak arm helps prevent shoulder pain.
Weeks to months

Early rehab

Therapy in hospital, then at home or in the community. Spasticity and shoulder pain often show up in this period.
Usually 3 to 6 months

Nerve pain may begin

Central post-stroke pain usually starts within 3 to 6 months, though it can begin earlier. You should have a review at about 6 months.
Months to years

Longer-term recovery

Many people keep improving for a long time. Ongoing pain is managed with medicine, therapy and self-help.

Timings are typical ranges, not exact rules. Tell your team about any new pain, whenever it starts.

When to get urgent help

Having one stroke raises the risk of another. Learn the FAST signs: Face drooping on one side, Arm weakness or numbness so you can't lift both arms, Speech slurred or confused, Time to call 999.

Call 999 if you have

any FAST sign, even if it goes away
sudden weakness or numbness on one side of the body
sudden loss of sight, confusion or dizziness with loss of balance
a sudden, very severe headache
a seizure (fit)

Don't drive yourself to A&E.

Call NHS 111 if

your pain suddenly becomes much worse
your arm or leg becomes hot, red and swollen
you have bad side effects from a new medicine, such as severe drowsiness
you can't get through to your GP and are worried

See your GP if

you have new or ongoing pain
your muscles are getting tighter or your hand or foot is curling
your shoulder is painful or stiff
you feel low, anxious or exhausted
you haven't had your 6-month review

Assessment and referral

There is no single test for pain after a stroke. Your team works out the cause from how the pain feels, where it is, when it started and an examination. For example, central post-stroke pain often feels burning or freezing and comes with changes in feeling, while shoulder pain is usually worse when you move the arm.

Your stroke team, community therapists or GP can refer you on. Depending on the cause, this might be to:

a physiotherapist or occupational therapist
a spasticity service, usually run by rehabilitation medicine or neurology teams
an NHS pain clinic, if pain is severe or stops you doing everyday things
a return-to-work or vocational rehab programme, where one is available

You should have a review about 6 months after your stroke, and then usually once a year. Use these to raise pain, stiffness and fatigue.

Treatments and medicines

The right treatment depends on the type of pain. Many people need a mix of medicine and therapy, and it can take some time to find what works.

Nerve pain medicines

Prescription from your GP or specialist

For central post-stroke pain. Ordinary painkillers usually don't help this type. Doctors may suggest amitriptyline, or gabapentin or pregabalin, which were first used for epilepsy. They usually take a few weeks to work fully. If one doesn't suit you, another can be tried.

Simple painkillers

From a pharmacy, or prescribed

Paracetamol can help shoulder, joint and muscle pain. Check with a pharmacist that it is safe with your other stroke medicines, especially before taking anti-inflammatories such as ibuprofen.

Muscle relaxants

Prescription

For widespread spasticity. Baclofen and tizanidine are tablets. Some others cause drowsiness. NICE says oral baclofen needs close monitoring.

Botulinum toxin

Injections from a specialist spasticity team

For spasticity in one area, such as the hand, wrist or ankle. Injections relax the tight muscles, with stretching and splints at the same time. The effect lasts about 3 months, and you are usually reassessed after 3 to 4 months.

Shoulder treatments

Therapists, GP or specialist

Supporting the arm, taping, electrical stimulation of the muscles, steroid injections into the joint, or a nerve block (an injection that numbs the main shoulder nerve). NICE lists all of these as options once the cause of the pain is clear.

Specialist options

Hospital spasticity or pain teams

For severe spasticity, baclofen can be given by a small pump placed under the skin. Pain clinics can also offer other injections and pain management programmes.

Don't stop nerve pain medicines suddenly

Medicines such as pregabalin and gabapentin need to be reduced slowly, with your doctor's advice, to avoid withdrawal effects. They can also make you drowsy, which matters if you drive or use machines at work.

Rehab and specialist options

Rehabilitation helps your brain and body relearn skills, and is one of the best ways to reduce pain and stiffness. NICE says people who are still affected by their stroke should be offered:

Intensive rehab

At least 3 hours a day, 5 days a week, based on your needs

A mix of physiotherapy, occupational therapy and speech and language therapy. In practice, not every area manages this yet, so it is worth asking what you should be getting.
Rehab at home

For as long as it helps you reach your goals

Many people go home early with support from a community stroke team. Rehab should carry on after you leave hospital.
Spasticity and shoulder care

From the early weeks, then as needed

Positioning, stretching, splints, electrical stimulation and, if needed, botulinum toxin. Starting early can help prevent contractures.
Pain clinic and pain management programmes

If pain lasts or is severe

Medicines, injections, physiotherapy and psychological support. Group programmes teach ways to live well with long-term pain, usually over several weeks.
Return-to-work programmes

When you feel ready

NICE recommends referral to a return-to-work programme, where available, for anyone who wants to work again.

Self-help and living well

Looking after a weak arm and shoulder

Support the arm on a pillow or armrest when sitting or lying
Ask carers not to pull on the weak arm when helping you move
Do the stretches your therapist gives you every day
Wear splints or supports as advised
Raise a swollen hand and keep the fingers moving

Managing pain and energy

Pace yourself and plan rest breaks
Notice what makes pain worse, such as cold, stress or tiredness
Try warmth, relaxation or a TENS machine if your team agrees
Stay as active as you safely can
Talk to someone if you feel low: your GP can refer you for talking therapy

If you have central post-stroke pain, changes in temperature or touch can set it off. Some people find loose clothing and avoiding cold draughts help.

Tips for getting the best treatment

Keep a pain diary

Note where the pain is, what it feels like (burning, aching, shooting, tight), when it happens, what makes it better or worse and what you have tried. This helps your team tell nerve pain from shoulder or muscle pain. If speech is hard after your stroke, a diary or a carer can help explain it for you.

Tell your team about pain at every appointment, even if they don't ask
Ask: "What type of pain do you think this is?" and "What is the next step if this doesn't work?"
Ask whether you should see a spasticity service or a pain clinic
Check you have had your 6-month review, and ask for one if not
Ask what rehab you are entitled to, and how long it will last
If things aren't improving, you can ask your GP for a second opinion
Bring a family member or carer to appointments if you can. Carers can ask their council for a carer's assessment

Returning to work

The effects of a stroke usually count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This includes hidden effects such as pain, fatigue and memory problems. Your employer must make reasonable adjustments to help you work. Examples include:

A phased return, building up hours slowly
Later start times to avoid rush hour
Regular rest breaks and a quiet space
A supportive, adjustable chair
One-handed keyboards or adapted mice
Voice-to-text software
Arm supports or a sit-stand desk
Written instructions and reminders
Large print or screen magnifiers
Time off for therapy and appointments

Access to Work can help pay for specialist equipment, a support worker, or taxis if you can't use public transport. You apply for it yourself.

Driving after a stroke

You must stop driving straight after a stroke. With a car or motorcycle licence, you can only start again after 1 month if your doctor says it is safe, and you must tell the DVLA if you still have problems such as weakness or sight loss. With a bus, coach or lorry licence, you must tell the DVLA and stop driving for at least a year. This matters if your job involves driving.

1 in 4 strokes in the UK happen to people of working age. (Stroke Association)

Benefits

If you are off sick, you may get Statutory Sick Pay. Depending on how the stroke affects you, you may be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, whether or not you work. If you can't work or are on a low income, you may qualify for Universal Credit or Employment and Support Allowance. Turn2us, Citizens Advice and the Stroke Association helpline can help you check.

How The Beyond Pain Foundation can help

If NHS rehab has ended, waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

A course of private neurological physiotherapy or occupational therapy
A private consultation with a pain or rehabilitation specialist
Hydrotherapy or a pain management programme
A TENS machine, electrical stimulation device or supports recommended by your therapist
Workplace or home equipment, such as a one-handed keyboard, voice-to-text software, a supportive chair or arm supports

We fund treatment, equipment and support, not general living costs. If Access to Work, your employer, the NHS or your council should provide something within a reasonable time, we'll ask you to try them first. Always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Stroke Association

Information and support service

Stroke Helpline 0303 3033 100. Also information guides, an online community and local support.

stroke.org.uk

Different Strokes

Charity for younger stroke survivors

Support for working-age stroke survivors and their families, including information packs and a helpline.

differentstrokes.co.uk

NHS

Health information

Stroke symptoms, treatment and recovery.

nhs.uk/conditions/stroke

Sources for this guide

Last reviewed: October 2026.