Prevalence, trajectory and predictors of post stroke pain: retrospective analysis of pooled clinical trial datasets

Ali, M. , Tibble, H., Brady, M. C., Quinn, T. J. , Sunnerhagen, K. S., Venketasubramanian, N., Shuaib, A., Pandyan, A. and Mead, G. (2023) Prevalence, trajectory and predictors of post stroke pain: retrospective analysis of pooled clinical trial datasets. Stroke, 54(12), pp. 3107-3116. (doi: 10.1161/STROKEAHA.123.043355) (PMID:37916457)

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.

• Item Type: Articles
• Additional Information: On behalf of the VISTA Collaboration. This study was originated from a writing group grant from British and Irish Association of Stroke Physicians/National Institute for Health and Care Research and supported through funding from the National Health Service Greater Glasgow and Clyde Endowment Fund.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quinn, Professor Terry and Ali, Dr Myzoon
• Authors: Ali, M., Tibble, H., Brady, M. C., Quinn, T. J., Sunnerhagen, K. S., Venketasubramanian, N., Shuaib, A., Pandyan, A., and Mead, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 02 November 2023
• Copyright Holders: Copyright © 2023 American Heart Association, Inc.
• First Published: First published in Stroke 54(12):3107-3116
• Publisher Policy: Reproduced in accordance with the publisher copyright policy