The trajectory of pain and pain intensity in the upper extremity after stroke over time: a prospective study in a rehabilitation population

Purpose: To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain. Materials and methods: Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0–10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively. Results: 678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0–7.0 at 3 and 3.0–6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time. Conclusions: The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time.IMPLICATIONS FOR REHABILITATION About one-third of patients with stroke reported upper extremity pain at 30 months after starting rehabilitation. In patients with stroke who reported persistent upper extremity pain, there was no significant change in pain intensity over time. There is room for improvement of diagnosis and treatment of upper extremity pain in patients with stroke.