Journal of Neurology

, Volume 257, Issue 9, pp 1446–1452 | Cite as

Post-stroke pain on long-term follow-up: the Bergen stroke study

  • Halvor Naess
  • Lene Lunde
  • Jan Brogger
  • Ulrike Waje-Andreassen
Original Communication

Abstract

The objective of this study is to evaluate characteristics and mortality related to long-term post-stroke pain (PSP). All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, between February 2006 and July 2009 received a postal questionnaire including the fatigue severity scale (FSS), the hospital anxiety and depression scale (HADSD), the Barthel index (BI), and questions regarding location of pain and pain severity at least 6 months after onset of stroke. Survival among patients returning the questionnaire was determined by November 2009. Stroke severity was defined by the modified Rankin score (mRS), 7 days after stroke onset. About 30% of the 408 patients had moderate to severe PSP. On logistic regression, PSP was associated with females (odds ratio (OR) = 2.1, p = 0.002), lower age (OR = 0.98, p = 0.04), fatigue (OR = 3.1, p < 0.001), sleep disturbances (OR = 3.3, p < 0.001), and mRS 3–5 (OR = 1.9, p = 0.03). Among patients with pareses (persistent or transient), there was no difference between paretic and non-paretic side as to frequency of limb pain on follow-up (p = 0.91). By November 2009, 26 patients had died. Cox regression analysis showed that mortality was associated with PSP (hazard ratio (HR) = 2.4, p = 0.040), high age (HR = 1.07, p = 0.001), males (HR = 2.5, p = 0.04), and low BI (HR = 0.97, p < 0.001). In conclusion, our study indicates a multifactorial basis for post-stroke pain. The main new findings were that the frequencies of pain were similar in paretic and non-paretic limbs and that long-term mortality was associated with post-stroke pain.

Keywords

Pain Fatigue Stroke Prognosis 

References

  1. 1.
    Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS (1995) Incidence of central post-stroke pain. Pain 61:187–193CrossRefPubMedGoogle Scholar
  2. 2.
    Appelros P (2006) Prevalence and predictors of pain and fatigue after stroke: a population-based study. Int J Rehabil Res 29:329–333CrossRefPubMedGoogle Scholar
  3. 3.
    Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163:2433–2445CrossRefPubMedGoogle Scholar
  4. 4.
    Brochet B, Michel P, Barberger-Gateau P, Dartigues JF (1998) Population-based study of pain in elderly people: a descriptive survey. Age Ageing 27:279–284CrossRefGoogle Scholar
  5. 5.
    Glader EL, Stegmayr B, Johansson L, Hulter-Asberg K, Wester PO (2001) 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 32:2124–2130CrossRefPubMedGoogle Scholar
  6. 6.
    Hardie K, Jamrozik K, Hankey GJ, Broadhurst RJ, Anderson C (2005) Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community Stroke Study. Cerebrovasc Dis 19:179–185CrossRefPubMedGoogle Scholar
  7. 7.
    Henon H (2006) Pain after stroke: a neglected issue. J Neurol Neurosurg Psychiatry 77:569CrossRefPubMedGoogle Scholar
  8. 8.
    Ingles JL, Eskes GA, Phillips SJ (1999) Fatigue after stroke. Arch Phys Med Rehabil 80:173–178CrossRefPubMedGoogle Scholar
  9. 9.
    Johnson CJ, Kittner SJ, McCarter RJ, Sloan MA, Stern BJ, Buchholz D, Price TR (1995) Interrater reliability of an etiologic classification of ischemic stroke. Stroke 26:46–51PubMedGoogle Scholar
  10. 10.
    Jonsson AC, Lindgren I, Hallstrom B, Norrving B, Lindgren A (2006) Prevalence and intensity of pain after stroke: a population-based study focusing on patients’ perspectives. J Neurol Neurosurg Psychiatry 77:590–595CrossRefPubMedGoogle Scholar
  11. 11.
    Jorngarden A, Wettergen L, von Essen L (2006) Measuring health-related quality of life in adolescents and young adults: Swedish normative data for the SF-36 and the HADS, and the influence of age, gender, and method of administration. Health Qual Life Outcomes 4:91CrossRefPubMedGoogle Scholar
  12. 12.
    Klit H, Finnerup NB, Jensen TS (2009) Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 8:857–868CrossRefPubMedGoogle Scholar
  13. 13.
    Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, Dick F, Taylor GS, Murray G (2000) Medical complications after stroke: a multicenter study. Stroke 31:1223–1229PubMedGoogle Scholar
  14. 14.
    Lundstrom E, Smits A, Terent A, Borg J (2009) Risk factors for stroke-related pain 1 year after first-ever stroke. Eur J Neurol 16:188–193CrossRefPubMedGoogle Scholar
  15. 15.
    Macfarlane GJ, McBeth J, Silman AJ (2001) Widespread body pain and mortality: prospective population based study. BMJ 323:662–665CrossRefPubMedGoogle Scholar
  16. 16.
    Naess H, Beiske AG, Myhr KM (2008) Quality of life among young patients with ischaemic stroke compared with patients with multiple sclerosis. Acta Neurol Scand 117:181–185CrossRefPubMedGoogle Scholar
  17. 17.
    Naess H, Nyland HI, Thomassen L, Aarseth J, Myhr KM (2005) Fatigue at long-term follow-up in young adults with cerebral infarction. Cerebrovasc Dis 20:245–250CrossRefPubMedGoogle Scholar
  18. 18.
    Naess H, Waje-Andreassen U (2009) Review of long-term mortality and vascular morbidity amongst young adults with cerebral infarction. Eur J Neurol 17:17–22Google Scholar
  19. 19.
    Rekand T, Albrektsen G, Langeland N, Aarli JA (2000) Risk of symptoms related to late effects of poliomyelitis. Acta Neurol Scand 101:153–158CrossRefPubMedGoogle Scholar
  20. 20.
    Schwartz JE, Jandorf L, Krupp LB (1993) The measurement of fatigue: a new instrument. J Psychosom Res 37:753–762CrossRefPubMedGoogle Scholar
  21. 21.
    Tellez N, Rio J, Tintore M, Nos C, Galan I, Montalban X (2005) Does the modified fatigue impact scale offer a more comprehensive assessment of fatigue in MS? Mult Scler 11:198–202CrossRefPubMedGoogle Scholar
  22. 22.
    Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR (2008) Validation of the fatigue severity scale in a Swiss cohort. Sleep 31:1601–1607PubMedGoogle Scholar
  23. 23.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Halvor Naess
    • 1
  • Lene Lunde
    • 2
  • Jan Brogger
    • 1
  • Ulrike Waje-Andreassen
    • 1
  1. 1.Department of NeurologyHaukeland University HospitalBergenNorway
  2. 2.Department of EconomicsUniversity of BergenBergenNorway

Personalised recommendations