national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
national-clinical-guidelines-for-stroke-fourth-edition
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National <strong>clinical</strong> guideline <strong>for</strong> <strong>stroke</strong><br />
6.19.3.2 Sources<br />
● pregabalin: start at 150 mg per day (divided into two doses; a lower starting dose<br />
may be appropriate <strong>for</strong> some people), with upward titration to an effective dose or<br />
the person’s maximum tolerated dose of no higher than 600 mg per day (divided<br />
into two doses).<br />
B Based on both the early and subsequent regular <strong>clinical</strong> reviews:<br />
● if there is satisfactory improvement, continue the treatment; consider gradually<br />
reducing the dose over time if improvement is sustained<br />
● if amitriptyline as first-line treatment results in satisfactory pain reduction but the<br />
person cannot tolerate the adverse effects, consider oral imipramine or<br />
nortriptyline as an alternative.<br />
C If satisfactory pain reduction is not achieved with first-line treatment at the<br />
maximum tolerated dose, offer treatment with another drug instead of or in<br />
combination with the original drug:<br />
● if first-line treatment was with amitriptyline switch to or combine with oral<br />
pregabalin<br />
● if first-line treatment was with pregabalin, switch to or combine with oral<br />
amitriptyline.<br />
A–C National Institute <strong>for</strong> Health and Clinical Excellence 2010c<br />
6.19.4 Musculoskeletal pain<br />
Musculoskeletal pain is not uncommon in people with <strong>stroke</strong>. Many patients have preexisting<br />
osteoarthritis or other painful arthritic conditions. Immobility and abnormal<br />
posture can cause pain. The most important specific musculoskeletal pain problem after<br />
<strong>stroke</strong>, post-<strong>stroke</strong> shoulder pain, has already been considered (see section 6.19.2).<br />
6.19.4.1 Recommendations<br />
6.19.4.2 Source<br />
A Any patient with musculoskeletal pain should be carefully assessed to ensure that<br />
movement, posture and moving and handling techniques are optimised to reduce the<br />
pain.<br />
B Any patient continuing to experience pain should be offered pharmacological<br />
treatment with simple analgesic drugs taken regularly.<br />
A–B Consensus<br />
6.20 Communication<br />
This section covers all aspects of communication including aphasia (a central abnormality<br />
of language, including both comprehension and expression), dysarthria (abnormality of<br />
articulation of speech which can result from both central and peripheral lesions) and<br />
apraxia of speech (specific isolated impairment of the ability to plan and execute the<br />
96 © Royal College of Physicians 2012
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