Prevalence and intensity of pain after stroke:: a population based study focusing on patients' perspectives
Prevalence and intensity of pain after stroke:: a population based study focusing on patients' perspectives
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DOI：
10.1136/jnnp.2005.079145
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发表时间：
2006-05-01
影响因子：
11
通讯作者：
Lindgren, A
中科院分区：
文献类型：
--
作者：
Jönsson, AC;Lindgren, I;Lindgren, A
目的：了解脑卒中后疼痛的发生率和强度，关注患者的观点。方法：在一年的时间里，416例首次中风患者被纳入以人口为基础的隆德卒中登记。4个月和16个月（中位）后，随访297例患者（98%的幸存者）。用视觉模拟量表（VAS）评估前48小时内的最严重疼痛强度，范围为0至100分：0至30分定义为无疼痛或轻度疼痛；40到100分为中度到重度疼痛。基线时评估NIH卒中量表（NIHSS）评分和HbA1c。在16个月时，使用老年抑郁量表（GDS-20）进行抑郁筛查，并使用迷你精神状态检查（MMSE）进行认知。通过多变量分析确定疼痛的预测因子。结果：4个月后，96例（32%）患者报告了中度至重度疼痛（VAS中位数= 60）。卒中发病时，疼痛的预测因子为年龄较小（p = 0.01）、女性（p = 0.006）、NIHSS评分较高（p < 0.001）和HbA1c升高（p = 0.001）。在16个月时，只有62例（21%）患者有中度至重度疼痛，但疼痛强度更严重（VAS评分中位数= 70;p < 0.016）。女性疼痛强度越大，GDS-20评分越差，MMSE评分越高，HbA1c升高。47%的患者持续疼痛，58%的患者睡眠受到干扰，40%的患者需要休息才能缓解疼痛。结论：虽然中风后疼痛的患病率随着时间的推移而下降，但16个月后，21%的患者有中度至重度疼痛。中风后的晚期疼痛平均更严重，并深刻影响患者的健康。
Objective: To determine prevalence and intensity of pain after stroke, focusing on patients' perspectives.Methods: During a one year period, 416 first-ever stroke patients were included in the population based Lund Stroke Register. After 4 and 16 months (median), 297 patients (98% of survivors) were followed up. Worst pain intensity during the previous 48 hours was assessed on a visual analogue scale (VAS), range 0 to 100: a score of 0 to 30 was defined as no or mild pain; 40 to 100 as moderate to severe pain. NIH stroke scale (NIHSS) score and HbA1c were assessed at baseline. At 16 months, screening for depression was done using the geriatric depression scale (GDS-20), and cognition with the mini-mental state examination (MMSE). Predictors of pain were determined by multivariate analyses.Results: Moderate to severe pain was reported by 96 patients (32%) after four months (VAS median = 60). Predictors of pain were younger age (p = 0.01), female sex (p = 0.006), higher NIHSS score (p < 0.001), and raised HbA1c (p = 0.001) at stroke onset. At 16 months, only 62 patients (21%) had moderate to severe pain, but pain intensity was more severe (median VAS score = 70; p < 0.016). Higher pain intensity correlated with female sex, worse GDS-20 score, better MMSE score, and raised HbA1c. Pain was persistent in 47%, disturbed sleep in 58%, and required rest for relief in 40% of patients.Conclusions: Although prevalence of pain after stroke decreased with time, after 16 months 21% had moderate to severe pain. Late pain after stroke was on average more severe, and profoundly affected the patients' wellbeing.