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Risk factors for stroke-related pain 1 year after first-ever stroke
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Stroke)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine.
2009 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 16, no 2, 188-193 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To estimate the prevalence of stroke-related pain and to explore its relation to spasticity.

DESIGN:

Cross-sectional survey.

PATIENTS AND METHODS:

One hundred and forty patients were examined at 1 year after first-ever stroke. Pain was assessed by a structured interview and categorized as stroke-related or not, pain intensity by use of the visual analogue scale (VAS), spasticity by use of the modified Ashworth scale, stroke severity and the presence of specific neurological impairments by use of the National Institute of Health Stroke Scale (NIHSS), and depression by use of the Montgomery-Asberg Depression Scale.

RESULTS:

Pain was reported by 68 patients (49%) with a mean VAS of 42 (95% CI 36-47). In 29 patients (21%), pain was categorized as stroke-related pain. Univariate analyses demonstrated correlations between stroke-related pain and total NIHSS score, paresis, sensory disturbance, depression and spasticity respectively. A multiple regression analysis demonstrated an independent association of stroke-related pain with paresis (OR = 3.1, 95% CI 1.2-7.7), sensory disturbance (OR = 3.1, 95% CI 1.1-8.9) and depression (OR = 4.1, 95% CI 1.4-13).

CONCLUSIONS:

The estimated prevalence of stroke-related pain was 21%. Stroke-related pain was associated with sensorimotor impairments and depression, but not with spasticity as an independent variable.

Place, publisher, year, edition, pages
2009. Vol. 16, no 2, 188-193 p.
Keyword [en]
depression, pain, prevalence, sensorimotor impairment, spasticity, stroke, stroke-related pain
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-103416DOI: 10.1111/j.1468-1331.2008.02378.xISI: 000262468900016PubMedID: 19138338OAI: oai:DiVA.org:uu-103416DiVA: diva2:218193
Available from: 2009-05-19 Created: 2009-05-19 Last updated: 2013-03-20Bibliographically approved
In thesis
1. Spasticity after first-ever stroke
Open this publication in new window or tab >>Spasticity after first-ever stroke
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no data on the prevalence of disabling spasticity.The reported prevalence of pain after stroke varies between 19% and 74%, whether pain is associated with spasticity is not known. Until now, there is no health economic analysis of patients with spasticity after stroke.

Methods: Two groups of patients were studied.

Cohort I was a cross-sectional survey. A representative sample of 140 patients was investigated 1 year after their first-ever stroke. Spasticity was defined as ≥ 1 score on the modified Ashworth scale, disabling spasticity was defined as spasticity having such an impact that intervention, e.g. intensive physiotherapy, orthoses or pharmacological treatment, should be offered. Pain was assesed with the Visual Analogue Scale. All direct costs during one year were identified and converted into Purchasing Power Parities US dollar (PPP$).

Cohort II was a prospective cohort study. Forty-nine patients were examined at day 2–10, at one month, and at six months after their first-ever stroke. Assessment and definitions were similar as for cohort I.

Results: Spasticity occurs within 1 month and disabling spasticity occur within 6 months.

After one year, the prevalence of spasticity was 17% and that of  disabling spasticity 4%. Disabling spasticity was more frequent in the upper extremity. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60).

The prevalence of stroke-related pain was 21% after one year. Stroke-related pain was associated with paresis (OR 3.1, 95% CI 1.2–7.7), sensory disturbance (OR 3.1, 95% CI 1.1–8.9) and depression (OR 4.1, 95% CI 1.4–13), but not with spasticity as an independent variable.

The majority of the direct costs for one year (78%) were associated with hospitalization, whereas 20% was associated with municipality services. Only 1% of all direct costs were related to primary health care and 1% to medication. The mean (median, inter-quartile range) direct cost for stroke patients with spasticity was PPP$ 84 195 (72 116, 53 707) compared to PPP$ 21 842 (12 385, 17 484) for stroke patients without spasticity (P < 0.001).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 103 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 467
Keyword
stroke, spasticity, upper motor neuron syndrome, UMN syndrome, prevalence, incidence, prediction, disabling spasticity
National Category
Neurology
Research subject
Rehabilitation Medicine; Neurology
Identifiers
urn:nbn:se:uu:diva-107134 (URN)978-91-554-7567-3 (ISBN)
Public defence
2009-09-04, Enghoff-salen, Ingång 50, bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-08-17 Created: 2009-07-18 Last updated: 2010-12-13Bibliographically approved

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Lundström, ErikSmits, AnjaTerént, Andreas

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