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| Persistent pain common after stroke |
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05 April 2006
Results of a study published in the May issue of the Journal of Neurology, Neurosurgery, and Psychiatry suggest that patient-reported pain is common shortly after stroke and the pain may persist for months.
Dr Ann-Cathrin Jonsson and colleagues from Lund University Hospital, Sweden, examined the prevalence, intensity and predictors of pain following stroke from the patients' perspectives. A total of 297 first-time stroke patients were registered in the Lund Stroke Register and selected based on their ability to complete the visual analog scale (VAS). VAS scores of 0 to 30 were defined as no or mild pain and scores of 40 to 100 were considered to be moderate to severe pain.
After 4 months, 96 patients (32%) reported moderate to severe pain, 23 had mild pain, and 178 had no pain. Significant predictors of pain included younger age, female sex, higher NIH stroke scale score, and higher HbA1c value. At 16 months, 62 patients (21%) had moderate to severe pain, 12 patients had mild pain, and 223 had no pain. Pain intensity was more severe at 16 months than at 4 months, with median VAS scores of 70 and 60, respectively, (p=0.016). A correlation was noted between higher pain intensity and female sex, worse geriatric depression scores, better mini-mental state examination score, and higher HbA1c baseline values. Pain was constant in up to 47% of subjects reporting pain at both follow-up assessments, and was often present in up to 68%. Disturbed sleep attributed to pain occurred in at least 49% to 58% patients with moderate to severe pain. At both follow-up periods, up to 50% of patients required temporary rest for pain relief and about 25% obtained pain relief only by changing position.
In an accompanying editorial, Dr Hilde Henon, of Lille University Hospital, France, notes that "because of the high prevalence of pain in stroke patients, it is necessary to educate physicians, including neurologists and stroke physicians, who, in most cases, do not consider pain an important concern in stroke patients, as suggested by the small number of publications on this topic."
Reference:
J Neurol Neurosurg Psychiatry 2006; 77 (5): 590-595.
J Neurol Neurosurg Psychiatry 2006; 77 (5): 569.
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