Frequency of Central Post-Stroke Pain and Its Impact on Quality of Life

Abstract

Objective: This study aims to determine the frequency of central post-stroke pain (CPSP) in a patient population with stroke as well as investigating the relationship between CPSP and patients' clinical/demographic characteristics, pain intensity, functional status, and quality of life. Methods: The study included 150 patients, who had a stroke and were aged 18 years and above. Demographic data of the patients, time since onset, and etiology, localization of the cerebral lesion, affected side, ambulation status, and Brunnstrom stages were recorded. Douleur neuropathique 4 questions (DN4) were used to assess the presence of CPSP. Visual Analog Scale (VAS) was used for pain intensity, functional ambulation scale (FAS) was used for ambulation status, Barthel Index (BI) was used for functional status, and the stroke impact scale (SIS) was used for quality of life. Results: The mean age of the patients was 67±11.5 years, 54.7% was male, and 45.3% was female. CPSP was evaluated in 15.3% of patients. There was no significant difference between the affected side of the body and age, gender, time since onset, BI scores, and ambulation status of patients according to their CPSP status (p>0.05). There was no statistically significant difference between SIS sub-parameter scores and the presence of CPSP (p>0.05). In correlation analysis, a significant relationship was found between Barthel Indexes and all SIS domains except memory and emotion (p <0.01). Conclusion: CPSP can be seen with varying frequency in stroke patients. In our study, the negative effect of the presence of CPSP on quality of life was not demonstrated.

Keywords

• central post-stroke pain; quality of life; stroke impact scale
• quality of life
• stroke impact scale

İnme Sonrası Santral Ağrının Sıklığı ve Yaşam Kalitesine Etkisi

Abstract

Amaç: Bu çalışma, inmeli bir hasta popülasyonunda inme sonrası santral ağrı (İSSA) prevalansını belirlemeyi ve İSSA ile hastaların klinik/demografik özellikleri, ağrı şiddeti, fonksiyonel durumu ve yaşam kalitesi arasındaki ilişkiyi araştırmayı amaçlamaktadır. Yöntemler: Çalışmaya 18 yaş ve üzeri inme geçirmiş 150 hasta dahil edildi. Hastaların demografik verileri, inme sonrası geçen süre, etiyoloji, serebral lezyonun lokalizasyonu, etkilenen taraf, ambulasyon durumu ve Brunnstrom evreleri kaydedildi. İSSA varlığını değerlendirmek için Douleur nöropatik 4 (DN4) ölçeği kullanıldı. Ağrı şiddeti için görsel analog skala (VAS), ambulasyon durumu için fonksiyonel ambulasyon skalası (FAS), fonksiyonel durum için Barthel İndeksi (BI) ve yaşam kalitesi için inme etki skalası (SIS) kullanıldı. Bulgular: Hastaların yaş ortalaması 67±11,5 yıl, %54.7'si erkek, %45.3'ü kadındı. İSSA hastaların %15.3'ünde saptandı. Hastaların İSSA durumlarına göre etkilenen taraf ile yaş, cinsiyet, inme sonrası geçen süre, BI skorları ve ambulasyon durumları arasında anlamlı fark yoktu (p>0.05). SIS alt parametre puanları ile İSSA varlığı arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Korelasyon analizinde Barthel İndeksleri ile bellek ve duygu dışındaki tüm SIS alt parametreleri arasında anlamlı bir ilişki bulundu (p<0.01). Sonuç: Kötü fonksiyonel durum, inme sonrası ağrı şiddeti, ileri yaş ve sağ hemipleji varlığı yaşam kalitesini olumsuz etkilemektedir.

Keywords

• inme sonrası santral ağrı
• inme etki skalası
• yaşam kalitesi
• quality of life
• stroke impact scale

References

1. Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989;20:1407-1431.
2. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VEi Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 1980;58:113-130.
3. Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS. Incidence of central post-stroke pain. Pain 1995;61:187-193.
4. Kong KH., Woon VC., Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors. Arch Phys Med Rehabil. 2004;85:35-40.
5. Bogousslavsky J, Regli F, Uske A. Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology 1988;38:837-848.
6. Glader EL, Stegmayr B, Johansson L, Hulter-Asberg K, Wester PO. Differences in long term outcome between patients treated in stroke units and in general wards: a 2 year follow-up of stroke patients in Sweden. Stroke 2001;32:2124-2130.
7. Sulch D, Melbourn A, Perez I, Kalra L. Integrated care pathways and qulity of life on a stroke rehabilitation unit. Stroke 2002;33:1600-1604.
8. Widar M, Samuelsson L, Karlsson Tevenious S, Ahlström G. Long-term pain conditions after stroke. J Rehab Med. 2002;34:165-170.

9. Jönsson AC, Lindgren I, Hallström B, Norrving B, Lindgren A. Prevalence and intensity of pain after stroke: a population based study focusing on patients perspectives. J Neurol Neurosurg Psychiatry 2006;77:590-595.
10. Bowsher D. Central pain: clinical and physiological characteristics. J Neurol Neurosurg Psychiatry 1996;61:62-69.
11. Carod- Artal FJ, Ferreira Coral L, Stieven Trizotto D, Menezes Moreira C. Self and Proxy –report agreement on the Stroke Impact Scale. Stroke 2009;40:3308-3314.
12. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114:29-36.
13. Irdesel J: Treatment of Neuropathic Pain. Turk J Phys Med Rehab. 2005; 51 (Supplement A): A6-A15.
14. Lundström E, Smits A, Terent A, Borg J. Risk factors for stroke related pain 1 year after first-ever stroke. Eur J Neurol. 2009;16:188-193.
15. MacGowan DJ, Janal MN, Clark WC, Wharton RN, Lazar RM, Sacco RL, et al. Central poststroke pain and Wallenberg’s lateral medullary infarction: frequency, character and determinants in 63 patients. Neurology 1997;49:120-125.
16. Harno H, Haapaniemi E, Putaala J, Haanpaa M, Makela JP, Kalso E, et al. Central poststroke pain in young ischemic stroke survivors in the Helsinki young stroke registry. Neurology 2014;83:1147-1154.
17. Leijon G, Boivie J, Johansson I. Central post-stroke-pain – neurological symptoms and pain characteristics. Pain 1989;36:13-25.
18. Abubakar SA, Isezuo SA. Health Related Quality of Life of Stroke Survivors: Experience of a Stroke Unit. Int J Biomed Sci. 2012;8:183-187.
19. Patel MD, Tilling K, Lawrence E, Rudd AG, Wolfe CD, McKewitt G. Relationship between long term stroke disability, handicap and health-related quality of life. Age Ageing 2006;35:273-279.
20. Baumann M, Couffignal S, Le Bihan E, Chau N. Life satisfaction two-years after stroke onset: the effects of gender, sex occupational status, memory function and quality of life among stroke patients (Newsqol) and their family caregivers (Whoqol-bref) in Luxembourg. BMC Neurol. 2012;12:105.
21. Raju RS, Sarma PS, Pandian JD. Psychosocial Problems, Quality of Life and Functional Independence Among Indian Stroke Survivors. Stroke 2010;41:2932-2937.
22. Sharma JS, Fletcher S, Vassalo M. Strokes in the Elderly. Higher acute and 3rd month mortality. An explanation. Cerebrovasc Dis. 1999;9:2-9.
23. Fernandez-Concepcion O, Fiallo-Sanchez MC, Alvarez-Gonzalez MA, Roca MA, Concepcion-Rojas M, Chavez L. The quality of life of patients with strokes from the point of view of factors which may affect it. Rev Neurol. 2001;32:725-731.
24. Heikinheimo T, Chimbayo D. Quality of life after first-ever stroke: An interview-based study from Blantyre, Malawi. Malawi Medical Journal. 2015;27:50-54.
25. Kong KH, Yang SY. Health-related quality of life among chronic stroke survivors attending a rehabilitation clinic. Singapore Med J. 2006;47:213-218.
26. Kılıc Z, Erhan B, Gündüz B, Iska Elvan G. Central Post-Stroke Pain in Stroke Patients: Incıdence and the Effect on Quality of Life. Turk J Phys Med Rehab. 2015;61:142-147.
27. Guidetti S, Ytterberg C, Ekstam L, Johansson U, Eriksson G. Changes in the impact of stroke between 3 and 12 months post-stroke, assessed with the stroke impact scale. J Rehabil Med. 2014;46:963-968.
28. Kwok T, Lo RS, Wong E, Wai-Kwong T, Mok V, Kai-Sing W. Quality of life of stroke survivors a 1-year follow up study. Arch Phys Med Rehabil. 2006;87:1177-1182.
29. Widar M, Ek AC, Ahlström G. Coping with long-term pain after a stroke. J Pain Symptom Manage. 2004;27:215-225.
30. Tang SC, Lee LJ, Jeng JS, Hsieh ST, Chiang MC, Yeh SJ, et al. Pathophysiology of Central Poststroke Pain: Motor Cortex Disinhibition and Its Clinical and Sensory Correlates. Stroke 2019;50:2851-2857.
31. Wade DT, Hewer RL, Wood VA. Stroke: influence of patients sex and side of weakness on outcome. Arch Phys Med Rehabil. 1984;65:513-516.