Post-stroke pain syndromes in Africa: epidemiology, clinical phenotypes, and unmet needs in assessment and management

Stroke disproportionately affects Africa, where incidence and prevalence rates rank among the highest reported worldwide, and case-fatality remains high. As acute survival improves in many, though not all, African settings, the burden of chronic post-stroke sequelae is growing, yet non-motor complications such as pain remain comparatively neglected in both clinical practice and research relative to motor and cognitive outcomes. Post-stroke pain is a heterogeneous group of syndromes, including central post-stroke pain, hemiplegic shoulder pain, spasticity-related musculoskeletal pain, post-stroke headache, and complex regional pain syndrome, each with distinct mechanisms and management pathways. This narrative review summarizes the sparse but growing African evidence base on post-stroke pain epidemiology and clinical phenotypes, drawing on data from Egypt, Nigeria, Zimbabwe, Ghana, Kenya, South Africa, and Uganda, and situates it within global comparators. We identify substantial unmet needs across assessment, including the absence of pain-screening tools validated in African languages, limited diagnostic infrastructure, and low clinician awareness, and across management, including restricted pharmacological access, scarce rehabilitation workforce, limited access to interventional options, and the parallel, poorly integrated use of traditional and complementary medicine. We propose a research and policy agenda prioritizing validated assessment tools, phenotype-specific prevalence studies, and pragmatic, resource-appropriate management models suited to African health systems.