Analyzing Pain Patterns in Stroke Survivors in Outpatient Clinics: A Retrospective, Cross-Sectional, Observational...

Pain is one of the most common sequelae after a stroke. Yet it is under-recognized, under-treated, and under-investigated, with no standard care guidelines for management during post-stroke recovery.

The primary objective of this study was to capture the prevalence of pain and different pain types in stroke survivors.

The study included stroke survivors who completed a pre-visit telehealth review of systems instrument between March 1, 2020, and February 28, 2022. 442 out-patient subjects were identified and matched to their respective electronic health record from the incident stroke. Subjects were divided into pain and no-pain groups based on self-report of post-stroke pain. Bivariate analyses were performed to test the association between the patient's demographic and clinical characteristics and pain using t-tests or Wilcoxon rank sum tests for continuous variables and chi-square tests for categorical variables. Random forest imputation was used to address missing values. Multivariable analysis was performed using the logistic regression method.

Of the 442 subjects, 58% (N=258) reported pain, with 56% experiencing multiple pain types. Musculoskeletal pain (36%), Neuropathic pain (22%), and Headaches (17%) were the most common pain types. Only 20% of patients reporting pain used analgesics, with gabapentin (43%) and opioids (11%) being the most common prescriptions. Obstructive sleep apnea (OSA), history of recreational drug use, and gender showed a significant relationship with pain in univariate analysis. In the final logistic regression model, OSA (OR: 3.37, 95% CI: 1.34-9.80, p: 0.015) and history of recreational drug use (OR: 2.05, 95% CI: 1.16-3.83, p: 0.018) remained significant. The model achieved moderate discrimination with an AUC of 0.62.

Over half of stroke survivors experienced pain, with 30% reporting multiple pain types. The low rate of analgesic use (20%) and significant proportion of patients experiencing pain highlight the critical need for evidence-based pain management guidelines in post-stroke care.