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Original Contribution

Chronic Pain Syndromes After Ischemic Stroke

PRoFESS Trial

Martin J. O’Donnell, Hans-Christoph Diener, Ralph L. Sacco, Akbar A. Panju, Richard Vinisko, Salim Yusuf
and On Behalf of PRoFESS Investigators
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https://doi.org/10.1161/STROKEAHA.111.671008
Stroke. 2013;44:1238-1243
Originally published April 22, 2013
Martin J. O’Donnell
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Hans-Christoph Diener
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Ralph L. Sacco
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Akbar A. Panju
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Richard Vinisko
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Salim Yusuf
From the Population Health Research Group, McMaster University, Hamilton, Ontario, Canada (M.J.O'D., S.Y.); HRB-Clinical Research Facility, NUI Galway, Galway, Ireland (M.J.O’D.); Department of Neurology, University Hospital, Essen, Germany (H.-C.D.); Miller School of Medicine, University of Miami, Miami, FL (R.L.S.); Hamilton Health Sciences (A.A.P.) McMaster University, Hamilton, Ontario, Canada; Biostatistics Group (D.C.), Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (R.V.).
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Abstract

Background and Purpose—Chronic pain syndromes are reported to be common after stroke, but most previous epidemiological studies have generally included small cohorts of patients with relatively short-term follow-up. In a large cohort with ischemic stroke (Prevention Regimen for Effectively avoiding Second Stroke [PRoFESS] trial), we determined the prevalence, risk factors, and clinical consequence of new poststroke pain syndromes.

Methods—Within the PRoFESS trial (mean follow-up 2.5 years), a standardized chronic pain questionnaire was administered (at the penultimate follow-up visit) to all participants who reported chronic pain since their stroke and did not have a history of chronic pain before their index stroke. Multivariable logistic regression analyses were used to determine risk factors for poststroke pain (and pain subtypes), and the association between poststroke pain and cognitive (≥3 reduction in Mini-Mental State Examination score) and functional decline (≥1 increase in m-Rankin).

Results—In total, 15 754 participants were included; of which 1665 participants (10.6%) reported new chronic poststroke pain, and included 431 participants (2.7%) with central poststroke pain, 238 (1.5%) with peripheral neuropathic pain, 208 (1.3%) with pain from spasticity, and 136 participants (0.9%) with pain from shoulder subluxation. More than 1 pain subtype was reported in 86 participants (0.6%). Predictors of poststroke pain included increased stroke severity, female sex, alcohol intake, statin use, depressive symptoms, diabetes mellitus, antithrombotic regimen, and peripheral vascular disease. A new chronic pain syndrome was associated with greater dependence (odds ratio, 2.16; 95% confidence interval, 1.82–2.56). Peripheral neuropathy and pain from spasticity/shoulder subluxation were associated with cognitive decline.

Conclusions—Chronic pain syndromes are common after ischemic stroke and are associated with increased functional dependence and cognitive decline.

  • epidemiology
  • ischemic stroke
  • pain
  • Received July 13, 2012.
  • Accepted February 19, 2013.
  • © 2013 American Heart Association, Inc.
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    Chronic Pain Syndromes After Ischemic Stroke
    Martin J. O’Donnell, Hans-Christoph Diener, Ralph L. Sacco, Akbar A. Panju, Richard Vinisko and Salim Yusuf On Behalf of PRoFESS Investigators
    Stroke. 2013;44:1238-1243, originally published April 22, 2013
    https://doi.org/10.1161/STROKEAHA.111.671008

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    Chronic Pain Syndromes After Ischemic Stroke
    Martin J. O’Donnell, Hans-Christoph Diener, Ralph L. Sacco, Akbar A. Panju, Richard Vinisko and Salim Yusuf On Behalf of PRoFESS Investigators
    Stroke. 2013;44:1238-1243, originally published April 22, 2013
    https://doi.org/10.1161/STROKEAHA.111.671008
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