Pain and pain assessment in stroke patients with aphasia: a systematic review

Abstract

Background: Persons with aphasia (PWA) after stroke are less able or unable to communicate about their pain due to language, speech and/or cognitive impairment. Most commonly pain rating scales are used for the assessment of pain in PWA, which could not be applied to any patient aphasia because of their inability to communicate verbally their pain. Aims: This review aims to investigate the prevalence and incidence of pain in PWA after stroke, establish which pain assessment instruments are used, and examine whether they are feasible, valid and reliable. Methods & Procedures: A systematic literature search was made to identify studies on pain and pain assessment in PWA and persons without aphasia after stroke, or in patients with right and left hemispheric stroke. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used to evaluate the methodological quality of the studies and the properties of the measurement scales used. Outcomes & Results: The search yielded 10 articles. The vertical, mechanical and horizontal Visual Analogue Scale, Faces Pain Scale, Verbal Rating Scale, Numeric Rating Scale, categorical site-of-pain scale, and a pictorial scale of pain intensity were used to assess pain, as were the Short-Form 36 Health Survey and the Dartmouth COOP Charts Quality of Life Scales that each have one pain item. Prevalence of pain in PWA after stroke was reported in two studies and ranged from 43.8-87.5%. Most studies described pain assessment in PWA after stroke with mild-to-moderate aphasia, while patients with severe aphasia were excluded. Various pain assessment tools were used but their feasibility, validity and reliability were generally of low methodological quality. Conclusions: A feasible, reliable and valid instrument is not available for PWA after stroke.

Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review

“…A literature review on this topic was recently identified, 11 while other systematic reviews have focused on pain assessment tools for communicative palliative care patients 31 or patients with aphasia. 32 The small sample size of studies contributed significantly to reduce the overall quality scores. Other methodological problems such as the use of a translated but not validated tool also negatively influenced the ratings.…”

Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

“…Our findings of inconsistent and inconclusive evidence are not unique to stroke. A previous review of pain assessment in aphasia concluded that "a feasible, reliable and valid pain assessment instrument is not yet available" (14). Dementia is another clinical condition where pain is common but potentially difficult to assess.…”

“…As a test of search validity, we pre-specified two papers (one original research and one review) that should be returned on our literature search (1,18). As a further test we cross-checked our included papers with a systematic review of pain assessment in aphasia, recognizing that the topics were distinct but were likely to have considerable overlap (14).…”

“…Some are generic, some are specific to a certain pain syndrome and some are developed exclusively for stroke. At present there is no consensus on the best approach to assessing post-stroke pain and no standardized tool is recommended for research or practice (14). In the absence of a gold standard pain assessment in stroke survivors and with the great variety of assessment tools available, clinicians may struggle to know the most appropriate approach for their patients.…”

The Relationship Between Lifestyle with Chronic Pain and Pain Acceptance in Elderly with Stroke

“…Hemiplegic pain is one of the types of pain in patients with stroke, with an estimated prevalence of 16% to 84% (7,14,15). Also, in the study by Mazzocato et al 69% of patients had pain (16), and in a review article by de Vries et al it was shown that between 87.3% and 87.8% of patients experienced pain, indicating the importance of pain in these patients (17).…”