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November 2006

A Closer Look at Pain After a Stroke

Pain persists, changes location, and can worsen sharply over time. A recent population-based Swedish study followed 416 adults who had experienced their first stroke in order to assess the intensity, prevalence, and location of pain. The authors of this study analyzed predictive factors to determine how the stroke victim’s experience of pain had changed over time. (Johnson A-C et al. Journal of Neural Neurosurg Psychiatry 2006 Volume 77) According to the authors, 74% of stroke patients experience pain after a stroke. Unfortunately, very little attention has been given to the intensity of that pain or to its progression
over time.

The assessment of the nature of pain after a stroke and the identification of its causes were found to be very complex. It was identified that 40% of those who reported moderate-to-severe pain at the 2-day follow-up assessment had been in pain before they had experienced the stroke. After the occurrence of a stroke, participants were evaluated by a nurse specialist and a physical therapist at the four and 16 month markers. The researchers paid close attention to the patient’s pain assessments including the intensity, onset, possible causes, frequency, and efforts on sleep.

About one-third of the participants reported moderate-to-severe pain in the first few months, and by the 16 month marker the percentage of pain had decreased to 21%. More than one half of these patients with moderate-to-severe pain had difficulty sleeping which could have contributed to the debilitating fatigue often reported by the stroke survivors.

Not all of the results were so negative. One of the positive outcomes identified in the study indicated that the use of a pain measuring tool during hospitalization was not only helpful to identifying the pain and initiating treatment, but the patient also responded with less pain on reassessment. Also, these patients were capable of being discharged earlier than patients treated in a hospital where pain assessment is not performed. They reported less severity and often the absence of pain on reassessment when prescribed a regiment of pain treatment therapy upon discharge.

In conclusion, hospital staff must begin to include a thorough pain assessment immediately upon the patient’s admission to the hospital in addition to other protocols. By doing so, as this study identified, patients will recover sooner and are less likely to experience the long-lasting effects of pain as they resume their pre-hospitalization lives.

Brigitte Brus, RN BSN COS-C
Clinical Consultant, Briggs Corporation

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