Prevalence, Trajectory, and Predictors of Poststroke Pain: Retrospective Analysis of Pooled Clinical Trial Data Set
Myzoon Ali, Holly Tibble, Marian Brady, Terence J. Quinn, Katharina S. Sunnerhagen, Narayanaswamy Venketasubramanian, Ashfaq Shuaib, Anand Pandyan, Gillian Mead, Kennedy R. Lees, Anne W. Alexandrov, Philip M. Bath, Erich Bluhmki, Natan M. Bornstein, Christopher Chen, L. Claesson, J. Curram, Stephen M. Davis, HC Diener, Geoffrey A. Donnan, Marc Fisher, M. D. Ginsberg, Barbara Gregson, James C. Grotta, Werner Hacke, Michael G. Hennerici, Marc Hommel, Markku Kaste, Patrick D. Lyden, John R. Marler, Keith W. Muir, Christine Roffe, Philip Teal, N.G. Wahlgren, Steven Warach, Myzoon Ali, A. Ashburn, David Barer, Anne Barzel, Julie Bernhardt, Audrey Bowen, Avril Drummond, J. Edmans, Chloe J. English, John Gladman, Erin Godecke, Sinikka Hiekkala, Tammy Hoffman, L Kalra, Suzanne Kuys, Peter Langhorne, Ann Charlotte Laska, Kennedy R. Lees, Pip Logan, Björn Machner, Jacqui Morris, Allyson M Pollock, Valerie M. Pomeroy, Helen Rodgers, Catherine Sackley, Lisa Shaw, David J. Stott, Sarah Tyson, Paulette van Vliet, Marion Walker, William Whiteley, Daniel F. Hanley, Kenneth Butcher, Stephen M. Davis, Barbara Gregson, Kennedy R. Lees, Patrick D. Lyden, Stephan A. Mayer, Keith W. Muir, Thorsten Steiner
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.