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Prevalence and intensity of pain after stroke: a population based study focusing on patients’ perspectives

Department of Neurology, Clinical Sciences Lund, Lund University, Sweden

Correspondence to:
Correspondence to:
Ann-Cathrin Jönsson
Department of Neurology, Lund University Hospital, S-221 85 Lund, Sweden; ann-cathrin.jonsson{at}skane.se

Objective: To determine prevalence and intensity of pain after stroke, focusing on patients’ perspectives.

Methods: During a one year period, 416 first-ever stroke patients were included in the population based Lund Stroke Register. After 4 and 16 months (median), 297 patients (98% of survivors) were followed up. Worst pain intensity during the previous 48 hours was assessed on a visual analogue scale (VAS), range 0 to 100: a score of 0 to 30 was defined as no or mild pain; 40 to 100 as moderate to severe pain. NIH stroke scale (NIHSS) score and HbA1c were assessed at baseline. At 16 months, screening for depression was done using the geriatric depression scale (GDS-20), and cognition with the mini-mental state examination (MMSE). Predictors of pain were determined by multivariate analyses.

Results: Moderate to severe pain was reported by 96 patients (32%) after four months (VAS median = 60). Predictors of pain were younger age (p = 0.01), female sex (p = 0.006), higher NIHSS score (p<0.001), and raised HbA1c (p = 0.001) at stroke onset. At 16 months, only 62 patients (21%) had moderate to severe pain, but pain intensity was more severe (median VAS score = 70; p<0.016). Higher pain intensity correlated with female sex, worse GDS-20 score, better MMSE score, and raised HbA1c. Pain was persistent in 47%, disturbed sleep in 58%, and required rest for relief in 40% of patients.

Conclusions: Although prevalence of pain after stroke decreased with time, after 16 months 21% had moderate to severe pain. Late pain after stroke was on average more severe, and profoundly affected the patients’ wellbeing.

Abbreviations: ADL, activities of daily living; BI, Barthel index; CPSP, central post-stroke pain; DVT, deep venous thrombosis; GDS, geriatric depression scale; LSR, Lund Stroke Register; MMSE, mini-mental state examination; NIHSS, National Institutes of Health stroke scale; VAS, visual analogue scale

Keywords: pain; patient perspective; stroke; stroke management

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