Pain in stroke patients
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Prevalence and Types of Pain in Stroke Patients
Pain is a frequent and significant complication after stroke, affecting between 19% and 74% of patients depending on the study and the stage of recovery 2548. Common types of post-stroke pain include central post-stroke pain (CPSP), musculoskeletal pain, shoulder pain, spasticity-related pain, headache, and complex regional pain syndromes 17. Chronic pain develops more often in stroke patients than in the general population, with about 39% of stroke survivors reporting new chronic pain compared to 29% of matched controls 4.
Central Post-Stroke Pain (CPSP): Features and Prevalence
CPSP is a neuropathic pain syndrome caused by lesions in the central nervous system following a stroke. Its prevalence among all stroke patients is estimated at 1–11%, but it can be much higher (over 50%) in those with medullary or thalamic strokes 210. CPSP can start immediately after a stroke, within the first month, or even more than a year later, making long-term monitoring important 10. CPSP is often persistent, difficult to treat, and can severely reduce quality of life 2910.
Other Common Pain Syndromes After Stroke
Musculoskeletal pain, shoulder pain, and spasticity-related pain are also common, especially in the subacute and chronic stages of recovery 156. Headache is more likely to occur in the acute phase, while musculoskeletal and spasticity-related pain tend to increase over time 5. Shoulder pain and pain from increased muscle stiffness are more frequent in stroke patients than in the general population 4.
Risk Factors and Predictors for Post-Stroke Pain
Several factors increase the risk of developing pain after stroke. Younger age, female sex, higher stroke severity, higher BMI, longer hospital stays, depression, and higher blood sugar levels (HbA1c) are all associated with a greater likelihood of experiencing pain 348. Depression and cognitive troubles are both consequences and risk factors for post-stroke pain, further impacting quality of life 178.
Impact on Quality of Life and Function
Pain after stroke is linked to reduced participation in rehabilitation, impaired function, disturbed sleep, and lower overall quality of life 1378. Persistent pain can also contribute to depression and cognitive difficulties, creating a cycle that further hinders recovery 178.
Assessment and Management of Post-Stroke Pain
Despite its prevalence and impact, post-stroke pain is often underdiagnosed and undertreated 157. Clinical guidelines recommend regular assessment for pain in stroke survivors, especially in those at higher risk 17.
For CPSP, first-line pharmacological treatments include amitriptyline, lamotrigine, and gabapentinoids (such as gabapentin or pregabalin) 2910. Other medications and interventional therapies, like motor cortex stimulation or transcranial magnetic stimulation, may be considered for difficult cases 2910. Non-pharmacological approaches and early identification of at-risk patients are also important for prevention and management 17.
Conclusion
Pain is a common and complex problem after stroke, with significant effects on recovery and quality of life. It can take many forms, including central neuropathic pain, musculoskeletal pain, and spasticity-related pain. Risk factors include younger age, female sex, depression, and higher stroke severity. Regular assessment and a combination of pharmacological and non-pharmacological treatments are essential for improving outcomes in stroke survivors with pain.
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