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Recognising the pain of stroke

By Timothy Cocks Science and the world 05 Mar 2015

Brendon Haslam has been a NOI faculty member for a few years now. He was the driving force behind the development of the Pain, Plasticity and Rehabilitation course, and also teaches the Graded Motor Imagery course. Brendon has launched into an important PhD investigating pain after stroke, and we asked him to write a bit about himself and his research:

My involvement with the NOI group began in my search for further knowledge, so, like many before me, I attended an “Explain Pain” course. This sparked further interest and further courses looking into the possible role that strategies like “Graded Motor Imagery” could play in the management of complex patients with multiple problems. This then started me thinking about the stroke population, where mirror therapy had started to become a bit trendy, but lacked a real structure in how it was being applied.

At present, while mainly being a clinican in private practice and hospital rehabilitation, I’m also currently undertaking a PhD – investigating contributions, and possible processing involved, in upper limb pain in the post-stroke population. This craziness has been driven by my frustration at the lack of effective treatment interventions for this group (and indeed many others). While there is heaps of literature out there telling us how much of a problem pain is in this population, there is hardly anything out there telling us what we can do about it, and medications just don’t seem to work adequately, with worsening NNTs over time.

In pulling together a PhD advisory team, I have been truly blessed to have some real heavies in the pain and neuroscience world come on board, and we have put together a project we’re really excited about. We’ll be calling for your help very soon, but just wanted to get you thinking about it for now. It will all be done online through the noigroup website, and will require participation from people who have not had a stroke (for our controls) and those that have had, whether they have pain or not. We’ll combine the classic Recognise™  program (with a few twists) with some questionnaires that let us explore the sensory profile of participants and their symptoms (if they have any). From this, we hope to look at the possible effect of image recognition in these groups, along with altered sensation and more. We’ve deliberately designed it to complement some ongoing medication studies that are being carried out elsewhere, along with some concurrent studies that we are doing in Melbourne at present that are using imaging to look at neural networks involved in the stroke population.

Can you do anything to help? Not yet! But a call will go out very soon, and it would be great if you can help us rack up some big numbers to really have some research power for this group.

-Brendon Haslam

Brendon will be teaching Graded Motor Imagery, along with Martina Egan-Moog, in Geelong, Australia on 18 and 19 April 2015. Details and registration form are available here


  1. Good luck Brendon this is a fantastic quest that will profit the lives of many 👏👏👏

  2. davidbutler0noi

    I am nearing the end of my professional life of espousing pain treatments publicly but I am very guilty of missing vast groups of sufferers. Post stroke pain is one. I am guilty of thinking “of course you have shoulder pain – look at that arm hanging down pulling on all those ligaments”.

    Nearly 50% of people with stroke complain of pain 6 months after (Hansen A et al Eur J Pain 16:1128) and slowly the evidence for central sensitisation increases Sanchez N 2014 Semin Arthritis Reheum doi: 10.10.1016/semarthrit 2014:11:002). CRPS is common too. There is no reason why pain can’t be treated with modern methods. Its all about awareness. This should be very fruitful research Brendon.


    1. Something I have been wondering about for some time now regarding modern treatment methods such as neuroscience education, is in fact what you mention here with: it is all about awareness. You see, I have been working at a nursing home for elderly people with dementia, and also had affiliations at neurological rehab centers for younger patients with TBI. Where do we stand in modern pain management when cognitive awareness of the patient is limited? I have found some research about the management of pain in patient with dementia, and there seems to be a great deal of advice in the assessment of these challenging cases, and a lot of discussions about the pharmacological treatment. But what I fail to find is research about the non-pharmalogical physiotherapeutic methods available. When pain education is hindered by cognitive impairments what are our tools as physiotherapist in treating persistent pain disorders?

  3. davidbutler0noi

    Hi Cathrine,

    Thanks for the post. You touch on an almost untouched area when you ask……. ” where do we stand in modern pain management when cognitive awareness of the patient is limited. ” First – this is not just for elderly people with dementia or younger patients with TBI – it appears that cognitive deficits may be a feature of many chronic pain states (Berryman C et al 2014 Clin Psych Rev 34: 563) And there is no currently no standardised test, even for these groups without overt brain injury. Currently, some therapists may not even be aware that vagueness can be related to pain.

    In the group which you are involved in there is very little about about non-pharmacological pain treatment. We have discussed this issue here at NOI but perhaps the protectometer concept that we present in our Explain Pain handbook can help, especially with the awareness that “safety in me” neurotags such as loving touch, reassurance , stable routines, stable but contextually rich environments and preservation of dignity are actually pain treatments.

    Massive untouched research area this!


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