Abstract
BackgroundPain is a common and burdensome complication in patients with acute stroke. We assessed the impact of impaired communication in stroke patients on pain assessment and treatment.MethodsWe included 909 (507 male, mean age 71.8 years) patients admitted to our stroke unit from 01/2015 to 12/2015 in the analysis. Patients were assigned to four groups: able to communicate (AC), not able to communicate prior to index stroke (P-NAC), due to focal symptoms of index stroke (S-NAC), due to a reduced level of consciousness (C-NAC). Pain prevalence, documentation of pain and use of analgesics were evaluated. C-NAC patients were excluded from analyses regarding analgesic treatment due to relevant differences in patient characteristics.Results746 patients (82.1%) were classified as AC, 25 (2.8%) as P-NAC, 90 (9.9%) as S-NAC and 48 (5.3%) as C-NAC. Pain was documented on the Numeric Rating Scale and in form of free text by nurses and physicians. Nurses documented pain more frequently than physicians (p < 0.001). Pain prevalence was 47.0% (n.s. between groups). The use of analgesic medication increased from 48.7% in the AC group, to 76.0% in the P-NAC group, and 77.8% in the S-NAC group (p < 0.001). Opioid use was significantly more frequent in NAC patients (p < 0.001). The response to the treatment was poorly documented with significantly lowest rates in S-NAC patients (p < 0.001).ConclusionsOur study suggests that post-stroke pain in patients with inability to communicate is not attended enough, not systematically assessed and therefore not sufficiently treated.
Highlights
Pain is a common and burdensome complication in patients with acute stroke
Clinical data including baseline characteristics, stroke syndrome, clinical scores (National Institute of Health Stroke Scale, NIHSS; Glasgow Coma Scale, GCS; modified Rankin Scale, Modified Rankin Scale (mRS)), stroke treatment, and length of hospital stay as well as technical investigations were extracted from the stroke database
Classification as not able to communicate as a consequence of focal symptoms of index stroke (S-NAC) required documented lack of communicability together with an explaining stroke symptom in patients with unimpaired consciousness
Summary
Pain is a common and burdensome complication in patients with acute stroke. We assessed the impact of impaired communication in stroke patients on pain assessment and treatment. Medical complications are still a frequent and relevant problem in stroke patients due to their association with increased post-stroke mortality and disability [3]. Do patients suffer from the pain itself, the occurrence of post-stroke pain correlates with fatigue, depression, sleep disorders, increased mortality [7] and suicidality [10] as well as slower rehabilitation progress [14, 15]. A reliable and validated tool for PSP assessment is lacking, and common methods of pain assessment are not straightforwardly applicable in stroke patients [18].
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