Chronic pain syndromes appear common after ischemic stroke

Chronic pain syndromes appear to be common in patients who have had an ischemic stroke, according to a new study.

As part of the PRoFESS (Prevention Regimen for Effectively avoiding Second Stroke) trial, participants who reported having chronic pain after their stroke but no history of pain before their stroke were given a standardized chronic pain questionnaire at the next-to-last follow-up visit. Mean follow-up for PRoFESS was 2.5 years.

The researchers used multivariable logistic regression to determine risk factors for poststroke pain, pain subtypes, and any relation between poststroke pain and cognitive and functional decline. Cognitive decline was defined as a reduction of three points or more in Mini-Mental State Examination score (range, 0 to 30), and functional decline was defined as an increase of one or more points on the modified Rankin scale score (range, 0 to 5).

Study results were published early online April 4 by Stroke.

Of 15,754 participants, 1,665 (10%) reported having new chronic pain after their stroke. Four hundred thirty-one (2.7%) reported central pain, 238 (1.5%) reported peripheral neuropathic pain, 208 (1.3%) reported pain from spasticity, and 136 (0.9%) reported pain from shoulder subluxation. Eighty-six participants (0.6%) reported having more than one type of pain. More severe stroke, female sex, alcohol intake, statin use, depressive symptoms, diabetes, antithrombotic drugs, and peripheral vascular disease were all found to predict poststroke pain. All types of chronic pain syndrome showed an association with increased disability and dependence, while functional decline appeared to be associated with peripheral neuropathy, spasticity and shoulder subluxation.

The authors noted that they were not able to determine which pain medications participants used during the trial, that the trial excluded patients with intracerebral hemorrhage, and that they measured pain at only one point in time, among other limitations. However, they concluded that chronic pain syndromes appear to be common after ischemic stroke and have a negative effect on cognition and functional dependence. They called for clinical trials to investigate ways of preventing pain syndromes after stroke.