Experienced pain after stroke: a cross-sectional 5-year follow-up study

Abstract

Background: Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain. Methods: Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009-2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression. Results: A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years poststroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain. Conclusion: Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.

The Experience of Post-Stroke Pain and The Impact on Quality of Life: An Integrative Review

“…The third study [33] also found a significant association between pain and depression on both the DSM-IV (p = 0.081) and GDS (p = 0.009). The fourth study [3] identified higher levels of depression in individuals who reported more frequent pain compared with those reporting less frequent pain using the Risk of Stroke Scale (p < 0.001) this finding was supported by the anxiety/depression subscale of the EQ-5D (p < 0.001). All significant results were rated as moderately low risk of bias; therefore, it is probable that an association exists.…”

“…Further to this, depression was a significant explanatory factor for experiencing pain (Odds Ratio = 8.0). The significant finding by Westerlind et al, [3] was rated to have moderately low risk of bias whilst the significant result from Choi-Kwon et al [25] was rated to have a high risk of bias and the significant findings from Kong et al [28] and Naess et al [31] were rated as moderately high.…”

“…A small to medium effect size was calculated among patients with depression (Hedges'g = (2.89-2.97)/0.21 = 0.38) [39]. Westerlind et al [3] found those who experience more frequent pain had a significant increase (p < 0.001) of depression at 5 years post-stroke. Further to this, depression was a significant explanatory factor for experiencing pain (Odds Ratio = 8.0).…”

“…Post-stroke pain (PSP) occurs in around 10-39% of new stroke cases [1,2]. Around 40% of stroke cases experience some form of pain 5 years post-stroke [3]. The most common classification of pain is called central post-stroke pain (CPSP) identified in around 2.7% of total cases [2].…”

“…Headaches are also a cause of PSP; predominantly tension-type headaches [4]. Around 25% identify that their PSP needs are not met at 5 years [3]. Two-thirds of patients with CPSP report inadequate pain treatment or received no treatment at all [5].…”