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. 2023 Dec;54(12):3107-3116.
doi: 10.1161/STROKEAHA.123.043355. Epub 2023 Nov 2.

Prevalence, Trajectory, and Predictors of Poststroke Pain: Retrospective Analysis of Pooled Clinical Trial Data Set

Myzoon Ali  1   2 , Holly Tibble  3 , Marian C Brady  2 , Terence J Quinn  1 , Katharina S Sunnerhagen  4   5 , Narayanaswamy Venketasubramanian  6 , Ashfaq Shuaib  7 , Anand Pandyan  8 , Gillian Mead  9 ; VISTA Collaboration
Collaborators, Affiliations

Prevalence, Trajectory, and Predictors of Poststroke Pain: Retrospective Analysis of Pooled Clinical Trial Data Set

Myzoon Ali et al. Stroke. 2023 Dec.

Abstract

Background: Poststroke pain remains underdiagnosed and inadequately managed. To inform the optimum time to initiate interventions, we examined prevalence, trajectory, and participant factors associated with poststroke pain.

Methods: Eligible studies from the VISTA (Virtual International Stroke Trials Archives) included an assessment of pain. Analyses of individual participant data examined demography, pain, mobility, independence, language, anxiety/depression, and vitality. Pain assessments were standardized to the European Quality of Life Scale (European Quality of Life 5 Dimensions 3 Level) pain domain, describing no, moderate, or extreme pain. We described pain prevalence, associations between participant characteristics, and pain using multivariable models.

Results: From 94 studies (n>48 000 individual participant data) in VISTA, 10 (n=10 002 individual participant data) included a pain assessment. Median age was 70.0 years (interquartile range [59.0-77.1]), 5560 (55.6%) were male, baseline stroke severity was National Institutes of Health Stroke Scale score 10 (interquartile range [7-15]). Reports of extreme pain ranged between 3% and 9.5% and were highest beyond 2 years poststroke (31/328 [9.5%]); pain trajectory varied by study. Poorer independence was significantly associated with presence of moderate or extreme pain (5 weeks-3 months odds ratio [OR], 1.5 [95% CI, 1.4-1.6]; 4-6 months OR, 1.7 [95% CI, 1.3-2.1]; >6 months OR, 1.5 [95% CI, 1.2-2.0]), and increased severity of pain (5 weeks-3 months: OR, 1.2 [95% CI, 1.1-1.2]; 4-6 months OR, 1.1 [95% CI, 1.1-1.2]; >6 months, OR, 1.2 [95% CI, 1.1-1.2]), after adjusting for covariates. Anxiety/depression and lower vitality were each associated with pain severity.

Conclusions: Between 3% and 9.5% of participants reported extreme poststroke pain; the presence and severity of pain were independently associated with dependence at each time point. Future studies could determine whether and when interventions may reduce the prevalence and severity of poststroke pain.

Keywords: anxiety; depression; pain; prevalence; stroke.

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Conflict of interest statement

Disclosures Dr Pandyan has no personal disclosures, and he is employed by Bournemouth University and sits on the Board for the following: Wessex AHSN, ARC Wessex, and Wessex Health Partners. Dr Brady and the NMAHP Research Unit are funded by the Chief Scientist Office (CSO), Scotland. Dr Quinn was supported by Bayer for nonpromotional conference travel and holds an investigator-initiated research grant from Bristol-Myers Squibb and Pfizer on atrial fibrillation. The CSO supported his salary with a Senior Clinical Lecturer Fellowship and Program Grant. The other authors report no conflicts.