Mhangara C1,2, Naidoo V1, Ntsiea MV1
1University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, 2Parirenyatwa Hospital, Physiotherapy, Harare, Zimbabwe
Background: Central post-stroke pain (CPSP) is a debilitating, poorly diagnosed chronic pain which occurs after a stroke incident. It is under-treated and usually mismanaged. The prevalence of post-stroke pain in Zimbabwe has not been established and it is not known if this condition is being medically managed, and if so, the specific management provided is also unknown. It is not known if the medical management that is being carried out is according to international best practice guidelines. Stroke survivors may be handicapped by the various physical disabilities, but those whose activity limitations are further compounded by post-stroke pain have exacerbated reduction in quality of life, productivity, depression and poor social and economic parity.
Purpose: To establish the prevalence of central post-stroke pain and its management in stroke clinics at Parirenyatwa hospital in Harare, Zimbabwe.
Methods: The study was a cross-sectional design. Participants were sampled from the stroke clinic at Parirenyatwa Hospital in Zimbabwe. They were screened for central post-stroke pain using a researcher administered questionnaire and sensory testing. Medical professionals utilised a self-administered questionnaire to ascertain their management for central post-stroke pain.
Results: One hundred and sixty-six stroke patients were sampled. Fourteen of the 166 stroke patients (8.4%) had CPSP. None of the participants had a previous diagnosis of CPSP. Younger age ( 60 years), was significantly associated with CPSP, p 0.003; and this was the only significant bio-socio-economic factor. Pain characteristics of CPSP were hyperaesthesia 10(71%), electric shocks 9(64%), temperature allodynia 9(64%) and allodynia 12(86%). Thirty-six percent of the 14 participants with CPSP complained of frequent pain and 71% of patients reported pain of non-specific timing. Ten medical professionals were sampled. One (10%) medical professional reported using the Doleur Neuropathique 4 (DN4) (questionnaire used to diagnose neuropathic pain) and two (20%) reported using sensory tests. Nine patients (64%) with CPSP were on medication; four (44%) were on paracetamol and the same number were on weak opiates. One patient (11%) was on non-steroidal anti-inflammatory drugs; and none were on anti-convulsants or anti-depressants. Two (50%) medical doctors used weak opiates as second line management. Five patients (36%) reported receiving a combination of massage; stretching; general exercise and moist heat or cryotherapy. Occupational therapists and physiotherapists reported using general exercise as treatment
Conclusion(s): Central post-stroke pain accounts for 8.4% of the stroke population seen at Parirenyatwa hospital. Participants with CPSP reported receiving paracetamol and weak opiates as drug management and mostly general exercise as therapy. There is need to encourage the use of valid and reliable outcome measures and sensation testing for diagnosis of CPSP and appropriate management.
Implications: This study established the disease burden of CPSP and raised awareness of this condition amongst the stroke survivors as well as their medical caregivers. The study also helped shape the management of CPSP at Parirenyatwa hospital and to inform or heighten the awareness of treatment guidelines.
Keywords: Central post-stroke pain, Chronic pain
Funding acknowledgements: No funding
Purpose: To establish the prevalence of central post-stroke pain and its management in stroke clinics at Parirenyatwa hospital in Harare, Zimbabwe.
Methods: The study was a cross-sectional design. Participants were sampled from the stroke clinic at Parirenyatwa Hospital in Zimbabwe. They were screened for central post-stroke pain using a researcher administered questionnaire and sensory testing. Medical professionals utilised a self-administered questionnaire to ascertain their management for central post-stroke pain.
Results: One hundred and sixty-six stroke patients were sampled. Fourteen of the 166 stroke patients (8.4%) had CPSP. None of the participants had a previous diagnosis of CPSP. Younger age ( 60 years), was significantly associated with CPSP, p 0.003; and this was the only significant bio-socio-economic factor. Pain characteristics of CPSP were hyperaesthesia 10(71%), electric shocks 9(64%), temperature allodynia 9(64%) and allodynia 12(86%). Thirty-six percent of the 14 participants with CPSP complained of frequent pain and 71% of patients reported pain of non-specific timing. Ten medical professionals were sampled. One (10%) medical professional reported using the Doleur Neuropathique 4 (DN4) (questionnaire used to diagnose neuropathic pain) and two (20%) reported using sensory tests. Nine patients (64%) with CPSP were on medication; four (44%) were on paracetamol and the same number were on weak opiates. One patient (11%) was on non-steroidal anti-inflammatory drugs; and none were on anti-convulsants or anti-depressants. Two (50%) medical doctors used weak opiates as second line management. Five patients (36%) reported receiving a combination of massage; stretching; general exercise and moist heat or cryotherapy. Occupational therapists and physiotherapists reported using general exercise as treatment
Conclusion(s): Central post-stroke pain accounts for 8.4% of the stroke population seen at Parirenyatwa hospital. Participants with CPSP reported receiving paracetamol and weak opiates as drug management and mostly general exercise as therapy. There is need to encourage the use of valid and reliable outcome measures and sensation testing for diagnosis of CPSP and appropriate management.
Implications: This study established the disease burden of CPSP and raised awareness of this condition amongst the stroke survivors as well as their medical caregivers. The study also helped shape the management of CPSP at Parirenyatwa hospital and to inform or heighten the awareness of treatment guidelines.
Keywords: Central post-stroke pain, Chronic pain
Funding acknowledgements: No funding
Topic: Neurology: stroke; Neurology
Ethics approval required: Yes
Institution: University of Zimbabwe and Parirenyatwa hospital, University of the Witwatersrand
Ethics committee: Committee for the UZ College of Health Sciences and Parirenyatwa
Ethics number: JREC206/16 (University of the Witwatersrand: M160619)
All authors, affiliations and abstracts have been published as submitted.
