1. Epstein, Linda BSN, RN

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A recent population-based Swedish study followed 416 adults who experienced a first stroke to assess intensity, prevalence, and location of pain, as well as to determine predictive factors and how the stroke victims' experience of pain changed over time. According to the authors, previous studies have reported that between 19% and 74% of stroke patients experience pain after a stroke, but little attention has been paid to the intensity of that pain or to its progression over time.


The study participants were evaluated at four months and 16 months after their strokes by a nurse specialist and a physical therapist. The researchers paid particular attention to the patients' assessments of their pain, including its intensity, onset, possible causes, frequency, and effects on sleep.


About one-third of the participants reported moderate-to-severe pain in the first few months after the stroke. At 16 months, that proportion had decreased to 21%, although among those patients, the intensity of the pain had increased, sometimes substantially. Women's experience of pain overall was greater than that of men, and more than half of patients with moderate-to-severe pain at 16 months had difficulty sleeping, perhaps contributing to the debilitating fatigue often reported by stroke survivors.


Assessing the nature of pain after stroke and identifying its causes were found to be very complex. Information about additional strokes or other medical events occurring after the initial stroke was often unavailable, and 38% to 40% of those who reported being in moderate-to-severe pain at the two follow-up assessments had been in pain before they even had a stroke. Also, the proportion of people with cognitive decline was higher in the group reporting no or mild pain. The study also did not address the type or dosage of analgesic medications participants may have been taking.


Pain after stroke, the authors warn, "may be underrecognized and undertreated."


Linda Epstein, BSN, RN


Jonsson A-C, et al. J Neurol Neurosurg Psychiatry 2006;77:590-5.