Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study

BACKGROUND: Post-Stroke Pain (PSP) is a common and disabling complication, difficult to treat, that often decreases patients' quality of life (QoL). The hypothesis is that PSP may negatively affect rehabilitation treatment. AIM: To quantify and characterize pain in a sample of post---stroke patients undergoing rehabilitation and to investigate the impact of pain in slowing down or discontinuing the rehabilitation program. DESIGN: Multicenter cross--sectional study. SETTING: Inpatients and outpatients of rehabilitation department. POPULATION: One hundred and six subacute and chronic stroke patients. METHODS: Pain intensity was measured with the NRS or the PAINAD (if cognitive/language impairment was present); pain characteristics were assessed with the DN4, and NPSI questionnaire. Qol was measured with the SF--36. A clinical assessment and a semi-structured questionnaire on pain occurrence, impact, and management was administered by the physiotherapist in charge of the patients and by the physician. RESULTS: About 1/3 of the patients (32.9%) with normal cognitive/language reported pain occurrence after stroke; 81.8% of them had NRS ≥3 and 31.8% DN4≥4 (meaning neuropathic origin of pain). In about 20% of the patients the PAINAD was used to measure pain; 17.4% of them presented a score ≥3. In 24.5% of our sample, pain influenced rehabilitation treatment. In 16% of the whole sample, pain influenced patients' attention during rehabilitation session. Patients with hypoesthesia presented significantly higher neuropathic pain scores than patients with normal sensory function. Regarding QoL, we found that patients with higher neuropathic pain showed more severe deterioration of mental aspects of QoL, where patients with higher nociceptive pain presented more severe deterioration of physical aspects of QoL. CONCLUSIONS: The results from this multicenter study showed that in about ¼ of the patients, pain negatively influenced the rehabilitation program delaying the recovery and likely increasing the cost of rehabilitation. CLINICAL REHABILITATION IMPACT: Clinicians should pay more attention to pain, especially neuropathic pain, in post--stroke patients. Tailored pharmacological therapy, to treat and prevent pain, might improve patients' compliance during the rehabilitation process.