Defining post-stroke pain: diagnostic challenges

Recently, a new grading system for central post-stroke pain (CPSP) was proposed, which might be used to distinguish patients with stroke who have central neuropathic pain from patients who have peripheral pain. Accordingly, for a CPSP diagnosis, all other causes of pain have to be excluded. Although this criterion has its purpose for defining CPSP as a separate entity, a too rigorous distinction between central and peripheral post-stroke pain might have drawbacks as well. Most importantly, by strictly following the proposed grading system, central pain mechanisms could be missed or even disputed in patients with other types of post-stroke pain. This possibility is particularly relevant as “mixed��? pain and pre-existing pain are common after stroke.1 For this reason, we would like to emphasize that peripheral nociceptive pain after stroke might coincide with symptoms characteristic of CPSP. To lend support to our concern, we present recent data on post-stroke shoulder pain (PSSP).