Lindgren I1,2, Brogårdh C1,2, Gard G1,3
1Lund University, Department of Health Sciences, Lund, Sweden, 2Skåne University Hospital, Department of Neurology and Rehabilitation, Lund, Sweden, 3Luleå University of Technology, Department of Health Sciences, Luleå, Sweden
Background: Shoulder pain after stroke affects between 50% and 80% of all individuals with persistent upper extremity impairments, which can hinder the ability to perform daily activities.The underlying causes are considered to be multi-factorial and a precise diagnosis can be difficult to establish. Shoulder pain after stroke is shown to be associated with depression, decreased social participation and quality of life. In addition to pain medication, a variety of physical interventions are described in the literature to reduce the shoulder pain, but no specific intervention has been shown to be superior. Despite that shoulder pain after stroke could be a long-lasting problem no previous study has, to the best of our knowledge, described how the persons manage their pain.
Purpose: To explore strategies that persons with persistent shoulder pain after stroke use to manage their pain in daily life.
Methods: This is a qualitative study using semi-structured face-to-face interviews. Thirteen community-dwelling persons (six women; median age 65 years (range 57-77)) with shoulder pain after stroke were interviewed median two years after the pain onset by a physiotherapist. Data was analysed by content analysis.
Results: The participants described that they over time had learnt to manage their shoulder pain by adopting various practical and cognitive strategies. Three categories emerged from the the analysis:
(1) “Practical modifications to solve daily life problems” included use of aids when cooking, use of loose hanging clothes to make dressing easier, or receiving help from relatives;
(2) “Changed movement patterns and specific actions to mitigate the pain” included moving the arm gradually in non-painful ways, putting the painful arm in the shirt or coat sleeve before the non-painful arm when dressing, limited use or avoiding to use the painful arm and distracting pain through physical or social activities; and
(3) “Learned how to deal with the pain mentally” described strategies to either endure or ignore the pain as well as the importance of having an optimistic view. All participants used several strategies simultaneously. The strategies were experienced to be successful for some participants whereas others found them to be insufficient.
Conclusion(s): The findings in the present study indicate that persons with persistent shoulder pain after stroke use both practical and cognitive strategies to manage their pain.
Implications: Persons with persistent shoulder pain after stroke use various practical and cognitive strategies to manage their pain. From a clinical perspective, it is important that therapists understand the person's entire situation, his or her attitude to the pain and the preferred coping strategies. The rehabilitation should be based on both the biopsychosocial history of the pain and clinical examinations. Besides practical modifications, medical treatments, physiotherapy and general activity, a more cognitive behavioral approach with pain education may be needed in the stroke rehabilitation program in order to support a person with persistent shoulder pain to find or develop a useful cognitive pain strategy.
Keywords: Stroke, shoulder pain, coping
Funding acknowledgements: The Swedish Stroke Association, the Norrbacka-Eugenia Foundation, the Skåne University Hospital Academy of Care Science, the Färs & Frosta Foundation.
Purpose: To explore strategies that persons with persistent shoulder pain after stroke use to manage their pain in daily life.
Methods: This is a qualitative study using semi-structured face-to-face interviews. Thirteen community-dwelling persons (six women; median age 65 years (range 57-77)) with shoulder pain after stroke were interviewed median two years after the pain onset by a physiotherapist. Data was analysed by content analysis.
Results: The participants described that they over time had learnt to manage their shoulder pain by adopting various practical and cognitive strategies. Three categories emerged from the the analysis:
(1) “Practical modifications to solve daily life problems” included use of aids when cooking, use of loose hanging clothes to make dressing easier, or receiving help from relatives;
(2) “Changed movement patterns and specific actions to mitigate the pain” included moving the arm gradually in non-painful ways, putting the painful arm in the shirt or coat sleeve before the non-painful arm when dressing, limited use or avoiding to use the painful arm and distracting pain through physical or social activities; and
(3) “Learned how to deal with the pain mentally” described strategies to either endure or ignore the pain as well as the importance of having an optimistic view. All participants used several strategies simultaneously. The strategies were experienced to be successful for some participants whereas others found them to be insufficient.
Conclusion(s): The findings in the present study indicate that persons with persistent shoulder pain after stroke use both practical and cognitive strategies to manage their pain.
Implications: Persons with persistent shoulder pain after stroke use various practical and cognitive strategies to manage their pain. From a clinical perspective, it is important that therapists understand the person's entire situation, his or her attitude to the pain and the preferred coping strategies. The rehabilitation should be based on both the biopsychosocial history of the pain and clinical examinations. Besides practical modifications, medical treatments, physiotherapy and general activity, a more cognitive behavioral approach with pain education may be needed in the stroke rehabilitation program in order to support a person with persistent shoulder pain to find or develop a useful cognitive pain strategy.
Keywords: Stroke, shoulder pain, coping
Funding acknowledgements: The Swedish Stroke Association, the Norrbacka-Eugenia Foundation, the Skåne University Hospital Academy of Care Science, the Färs & Frosta Foundation.
Topic: Neurology: stroke; Pain & pain management; Disability & rehabilitation
Ethics approval required: Yes
Institution: Lund University
Ethics committee: Regional Ethical Review Board at Lund University
Ethics number: Reg no 2014/657
All authors, affiliations and abstracts have been published as submitted.
