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A number of mechanisms may be responsible for the pain experienced by the victim of a stroke. Associated neurological impairment may make it difficult for pain relief to be obtained by changing position, and expressive difficulty may result in the patient suffering silently. Interpretation of complaints may be made more difficult by the emotional lability and depression encountered in some patients. Although the term ‘thalamic pain’ referring to a specific lesion in the central nervous system (CNS) was first used in 1906, it is clear that lesions in any part of the central nervous system can result in neuropathic pain. The term central post-stroke pain (CPSP) is therefore more appropriate. However it is also very important to realize that stroke victims also experience nociceptive pain as a consequence of postural abnormalities, spasm, contractures and pressure areas, and it may be premature to conclude an automatic diagnosis of CPSP just because of the history of stroke. Pain arising from these other causes needs specific treatment.