Evaluation of central neuropathic pain and its relationship with quality of life in patients with stroke: a cross-sectional study

Abstract

Objectives: In addition to other complications in stroke patients, central post-stroke pain (CPSP) is sometimes overlooked. Considering the morbidities it causes in patients, it turns out to be a very important problem. The aim of this study is to investigate the frequency of CPSP, the factors causing CPSP, and the relationship between the CPSP and the quality of life and ambulation of individuals.

Methods: A cross-sectional study was conducted on a group of patients with stroke. One hundred forty stroke patients were included in the study. Pain (The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale), health-related quality of life (Short Form 36 Questionnaire) and ambulation (Functional Ambulation Classification) were evaluated. In addition, a special evaluation form was created for this study. With this form, demographic characteristics of the patients, stroke type, cerebral location and hemisphere affected in stroke were recorded. These data were collected for the period between May 2016 and January 2018. Patients were divided into two groups. Group 1 included patients with CPSP and Group 2 patients without neuropathic symptoms.

Results: CPSP was detected in 23 of 140 patients. In terms of demographic data, only gender differences were found between group 1 and group 2. CPSP was statistically significantly higher in female patients. There was no significant difference between the two groups in terms of the affected cerebral region and stroke type, but CPSP was significantly more common in patients with left hemispheric involvement. Emotional role restriction, body pain, social funtion, general health and mental health subcategories of the SF-36 were found to be significantly lower in group 1 compared to group 2. Also ambulation was worse in patients with CPSP.

Conclusions: It was concluded that CPSP is a common problem and negatively affects the quality of life of the patients. Therefore, CPSP should be recognized in the early period after stroke and treatments should be arranged accordingly.

Keywords

• Neuropathic pain
• stroke
• quality of life

References

1. 1. Klit HM, Finnerup NB, Jensen TS. Diagnosis, prevalence, characteristics, and treatment of central poststroke. Pain: Clin Updates 2015;23:1-7.
2. 2. Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou GM, et al. Prevalence and management challenges in central post-stroke neuropathic pain: a systematic review and meta-analysis. Adv Ther 2020;37:3278-91.
3. 3. Schwarzbach CJ, Grau AJ. [Complications after stroke: clinical challenges in stroke aftercare]. Der Nervenarzt 2020;91:920-5. [Article in German]
4. 4. Ramos-Lima MJM, Brasileiro IC, Lima TL, Braga-Neto P. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics (Sao Paulo) 2018;73:e418.
5. 5. Choi-Kwon S, Choi JM, Kwon SU, Kang DW, Kim JS. Factors that affect the quality of life at 3 years post-stroke. J Clin Neurol 2006;2:34-41.
6. 6. Naess H, Waje-Andreassen U, Thomassen L, Nyland H, Myhr KM. Health-related quality of life among young adults with ischemic stroke on long-term follow-up. Stroke 2006;37:1232-6.
7. 7. 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;87:1177-82.
8. 8. Xu XM, Luo H, Rong BB, Zheng XM, Wang FT, Zhang S-J, et al. Nonpharmacological therapies for central poststroke pain: a systematic review. Medicine (Baltimore) 2020;99:e2261.

9. 9. Aprile I, Briani C, Pazzaglia C, Cecchi F, Negrini S, Padua L, et al. Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study. Eur J Phys Rehabil Med 2015;51:725-36.
10. 10. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 2001;92:147-57.
11. 11. Yücel A, Senocak M, Orhan EK, Cimen A, Ertas M. Results of the leeds assessment of neuropathic symptoms and signs pain scale in Turkey: a validation study. J Pain 2004;5:427-32.
12. 12. Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.
13. 13. Koçyiğit H, Aydemir Ö, Fişek G, Ölmez N, Memiş A. Kısa Form-36 (KF-36)’nın Türkçe versiyonunun güvenilirliği ve geçerliliği. İlaç ve Tedavi Dergisi 1999;12:102-6.
14. 14. Williams G. Functional ambulation classification. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY, USA: Springer, 2011: pp. 1105-6.
15. 15. Klit H, Finnerup NB, Andersen G, Jensen TS. Central poststroke pain: a population-based study. Pain 2011;152:818-24.
16. 16. Mhangara CT, Naidoo V, Ntsiea MV. The prevalence and management of central post-stroke pain at a hospital in Zimbabwe. Malawi Medical Journal 2020;32(3):132-8. DOI: 10.4314/mmj.v32i3.5
17. 17. Bashir AH, Abdullahi A, Abba MA, Mukhtar NB. Central poststroke pain: its profile among stroke survivors in Kano, Nigeria. Behav Neurol 2017;2017:9318597.
18. 18. Naess H, Lunde L, Brogger J, Waje-Andreassen U. Post-stroke pain on long-term follow-up: the Bergen stroke study. J Neurol 2010;257:1446-52.
19. 19. Kılıç Z, Erhan B, Gündüz B, Iska Elvan G. Central post-stroke pain in stroke patients: incidence and the effect on quality of life. Turk J Phys Med Rehabil 2015;61:142-7.
20. 20. Osama A, Hagar AA, Elkholy S, Negm M, El-Razek RA, Orabi M. Central post-stroke pain: predictors and relationship with magnetic resonance imaging and somatosensory evoked potentials. Egypt J Neurol Psychiatr Neurosurg 2018;54:40.
21. 21. Vukojevic Z, Kovacevic AD, Peric S, Grgic S, Bjelica B, Basta I, et al. Frequency and features of the central poststroke pain. J Neurol Sci 2018;391:100-3.
22. 22. Elias GJB, De Vloo P, Germann J, Boutet A, Gramer RM, Joel SE, et al. Mapping the network underpinnings of central poststroke pain and analgesic neuromodulation. Pain 2020;161:2805-19.
23. 23. 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. Stroke 2013;44:1238-43.
24. 24. Şahin-Onat Ş, Ünsal-Delialioğlu S, Kulaklı F, Özel S. The effects of central post-stroke pain on quality of life and depression in patients with stroke. J Phys Ther Sci 2016;28:96-101.
25. 25. Choi-Kwon S, Choi SH, Suh M, Choi S, Cho K-H, Nah H-W, et al. Musculoskeletal and central pain at 1 year post-stroke: associated factors and impact on quality of life. Acta Neurol Scand 2017;135:419-25.
26. 26. Gokkaya NKO, Aras MD, Cakci A. Health-related quality of life of Turkish stroke survivors. Int J Rehabil Res 2005;28:229-35.
27. 27. Gorst T, Lyddon A, Marsden J, Paton J, Morrison SC, Cramp M, et al. Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke. Disabil Rehabil 2016;38:589-96.
28. 28. Hiraoka S, Maeshima S, Okazaki H, Hori H, Tanaka S, Okamoto S, et al. Factors necessary for independent walking in patients with thalamic hemorrhage. BMC Neurol 2017;17:211.