Prevalence and Intensity of Pain after Stroke A population-based study focusing on patients' perspectives

¹ Department of Neurology, Sweden

^* To whom correspondence should be addressed. E-mail: ann-cathrin.jonsson{at}skane.se.

Accepted 6 December 2005

	Abstract

Background and Purpose: To determine prevalence and intensity of pain after stroke focusing on patients' perspectives.

Methods: During a one-year period, we included 416 first-ever stroke patients 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 past 48 hours was assessed with visual analogue scale (VAS), range 0-100. VAS score 0-30 was defined as no-mild pain and 40-100 as moderate-severe pain. NIH stroke scale (NIHSS) score and HbA1c were assessed at baseline. At 16 months, we screened for depression with Geriatric Depression Scale (GDS-20), and assessed cognition with Mini Mental State Examination (MMSE). Predictors and other factors related to pain were determined by multivariate analyses.

Results: Moderate-severe pain was reported by 96 patients (32%) after 4 months (VAS median 60). Predictors of pain were younger age (p=0.01), female gender (p=0.006), higher NIHSS score (p<0.001) and elevated HbA1c (p=0.001) at stroke onset. At 16 months, only 62 patients (21%) had moderate-severe pain, but pain intensity was more severe (median VAS score 70; p<0.016). Higher pain intensity correlated with female gender, worse GDS-20 score, better MMSE score, and elevated 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-severe pain. Late pain after stroke was on average more severe, and profoundly affected patients' well-being.

Keywords: outcome, pain, patient perspective, stroke, stroke management

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