Features of cognitive and emotional‑volitional manifestations in patients with pain syndromes in restorative and residual periods of stroke

Abstract

Objective — to study the features of cognitive and emotional‑volitional manifestations, their correlation with pain syndromes and dynamics in patients in different periods of a stroke.Methods and subjects. A total of 62 patients with pain syndromes after stroke were examined, among them 24 women (mean age — 67.5 ± 1.9 years) and 38 men (mean age 71.6 ± 1.3 years). The main group included patients with pain syndrome at different periods after the stroke (early and late restorative, residual). The presence of aphasia and the MMSE (Mini‑Mental State Examination) test scores lower than 20 were the exclusion criteria from the study. For comparison of emotional‑volitional indicators, additional groups were recruited: patients with chronic pain syndromes without stroke (n = 30) and almost healthy persons (n = 30). Magnetic resonance imaging confirmed ischemic stroke in 80.65 % of patients, hemorrhagic stroke in 11.29 %, in others had a mixed character of the process. In the group of patients with stroke in the territory of the middle cerebral arteries (MCA), in 42.4 % of cases, the stroke was localized in the territory of the right MCA, in others — in the territory of the left MCA. In a group of patients with two or three strokes, a history of 6 had focal lesions in the blood pools of both SMA. In the residual period there were 73 patients. Deep hemiparesis was diagnosed in 9.67 % of patients, moderate — in 8.06 %, mild — in 61.29 %, pyramidal insufficiency — in 20.98 %. Among the 85.48 % of patients with static and coordination disorders, the severe ataxia was observed in 7.55 % patients, moderate ataxia — 47.17 %, and 45.28 % — mild to severe ataxia. All patients underwent cognitive evaluation on the MMSE scale. Reactive and personal anxiety was determined on the Spielberger —Khanin scale. All the studies were performed during admission to the neurological department.Results. The indicators of high personal and reactive anxiety in patients with painful poststroke syndromes are reliably (p < 0.05) different from those of almost healthy individuals, but identical to the patients with pain syndromes without a stroke (p > 0.05). The analysis of the anxiety depending on the periods of the stroke, showed an increase in the levels of reactive anxiety from the late recovery to residual periods. Reliable correlations between the level of reactive anxiety and intensity of dorsalgia r = 0.4 (p = 0.02), localization of headache r = 0.3 (p = 0.045) were revealed. There was a difference in the number of active complaints of patients and complaints as a result of a thorough survey, indicating insufficient attention to manifestations and timely treatment of chronic pain, sleep disorders, etc. in poststroke patients.Conclusions. High rates of personal and reactive anxiety in poststroke patients correspond to similar dependencies of the intensity of pain syndromes from the period of a stroke, which is important for the formation of appropriate rehabilitation measures.