Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study

Schuster, Jean-Pierre; Hoyer, Carolin; Ebert, Anne; Alonso, Angelika

doi:10.1186/s12883-020-1606-x

Cited by 7 publications

(14 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pain assessment represents an important issue in non-communicative patients, who can have difficulties to describe their pain, contributing to behavioral disturbances in some neurological conditions (Scuteri et al, 2017;Scuteri et al, 2018;Scuteri et al, 2019a;Scuteri et al, 2019b). Indeed, in the real-life clinical setting, the use of opioids in patients with post-stroke pain, who are not able to communicate is frequent, but the response to treatment is unclear (Schuster et al, 2020). Post-stroke pain can occur also in patients with neurodegenerative disorders (Scherder and Plooij, 2012) and clinical trials to assess the efficacy and safety of opioids are needed, being the treatment of pain often inappropriate in this population (Scuteri et al, 2017;Scuteri et al, 2018;Scuteri et al, 2020a;Scuteri et al, 2020b).…”

Section: Discussionmentioning

confidence: 99%

Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: Post-stroke pain is one of the most common sequelae of stroke, which stands among the leading causes of death and adult-acquired disability worldwide. The role and clinical efficacy of opioids in post-stroke pain syndromes is still debated.Objectives: Due to the important gap in knowledge on the management of post-stroke pain, this systematic review aimed at assessing the efficacy of opioids in post-stroke pain syndromes.Methods: A literature search was conducted on databases relevant for medical scientific literature, i.e. PubMed/MEDLINE, Scopus, Web of Science and Cochrane Library databases from databases inception until August 31st, 2020 for clinical trials assessing the effects of opioids and opioid antagonists on pain reduction and pain related symptoms in patients with post-stroke pain syndromes. Studies assessing the effects of other medications (e.g., tricyclic antidepressant, pregabalin) or non - pharmacological management strategies (e.g., neurostimulation techniques) were excluded. The selected studies have been subjected to examination of the risk of bias.Results: The literature search retrieved 83,435 results. After duplicates removal, 34,285 articles were title and abstract screened. 25 full texts were assessed and 8 articles were identified to be eligible for inclusion in the qualitative summary and narrative analysis, of which three were placebo-controlled and two were dose-response. Among placebo-controlled studies, two evaluated the analgesic effect of morphine and one assessed the effects of the opioid antagonist naloxone on patients with central post-stroke pain. With regard to dose-response studies, both were on patients with central post-stroke pain, one assessing the efficacy of levorphanol, and the other on naloxone. Seven out of eight included studies showed an overall slight analgesic effect of opioids, with less consistent effects on other pain-related symptoms (e.g., mood, quality of life). The randomized controlled trials were subjected to meta-analysis and rating of the quality of evidence for the two outcomes considered according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations) system. The overall results are inconclusive because of the small number of studies and of patients.Conclusions: The limited number of the included studies and their heterogeneity in terms of study design do not support the efficacy of opioids in post-stroke pain and in pain-related outcomes. Large double-blind randomized clinical trials with objective assessment of pain and related symptoms are needed to further investigate this topic.

show abstract

Section: Discussionmentioning

confidence: 99%

Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…One study focused on objective pain assessment in patients with stroke-related aphasia, with the assessment compared with pain self-report 25 . The participants received care in various hospital settings, such as rehabilitation units, 19,21,23,27 comprehensive stroke units, 22,25 and in palliative care 26 . Descriptive research design was the most common study design identified 19,21,23,24,26,27 .…”

Section: Resultsmentioning

confidence: 99%

Assessment instruments used for self-report of pain in hospitalized stroke patients with communication problems: a scoping review

Mandysová

Klugarová

Matějková

et al. 2021

JBI Evidence Synthesis

View full text Add to dashboard Cite

Objective:The objective of this scoping review was to identify assessment instruments used for the self-report of pain by hospitalized patients who have had a stroke and who have communication problems.Introduction:Pain assessment in various patient groups has received considerable attention, and a variety of pain assessment instruments exists. Nevertheless, there is a lack of consensus regarding which pain assessment instruments are used for self-report of pain in stroke patients with communication problems.Inclusion criteria:This review included articles that focused on hospitalized adults who have had a stroke, have communication problems attributable to a stroke, and describe the use of an assessment instrument for the self-report of pain. The scoping review considered systematic reviews, quantitative and qualitative studies, and mixed method studies.Methods:Ten databases were searched from inception to August 2020, using Embase as the key information source (it yielded 424 papers). Hand-searching of the references of the included articles yielded an additional 12 papers. Papers written in any language were considered. A data extraction table was created to record relevant information in line with the goals and results of each article, the sample studied, and the pain assessment instrument used.Results:Ten papers were included in the review, most of which were descriptive studies. Most papers were from the United Kingdom and the United States. The most common communication problem in stroke patients was aphasia. The participants received care in various hospital settings (eg, rehabilitation units, comprehensive stroke units, palliative care). Eleven assessment instruments were identified. In most cases, the assessment instruments focused on assessing pain presence and pain intensity. The most frequently used unidimensional pain intensity instrument was the numerical rating scale. Four instruments were multidimensional, of which two assessed health-related quality of life, including pain. The most thorough pain assessment instrument was the ShoulderQ, which contains 10 verbal questions and three visual vertical graphic rating scales that focus on the assessment of stroke-related shoulder pain.Conclusions:A range of both unidimensional and multidimensional self-report pain instruments was identified; however, of all the possible communication problems, most studies focused solely on patients with mild to moderate aphasia. Therefore, further research is recommended, including studies that also enroll patients with various stroke-related communication problems other than aphasia. In addition, the instruments should be translated for research in non-Western countries. Finally, apart from descriptive studies, experimental research with a robust randomized controlled trial design is needed to examine the effect of pain-inducing procedures on the perceived pain in patients with stroke-related communication problems.

show abstract

“…Deși toate tipurile de durere apar secundar aceleiași patologii, AVC, fiecare se manifestă diferit și are la bază mecanisme diferite: atât mecanice, nocicepti-ve și periferice (durerea de umăr, durerea secundară spasticității), cât și nociceptive, neuropate sau mixte (durerea centrală post AVC, CRPS) [7,40]. Astfel, în controlul durerii post AVC este fezabil de a introduce diverse direcții de tratament, care să includă tratament farmacologic cu preparate antidepresante, antiepileptice, glucocorticosteroizi și miorelaxante, suplimentate de fizioterapie, terapie ocupațională și tehnici cognitiv-comportamentale [3,47].…”

Section: Discuțiiunclassified

“…Conform cercetărilor recente, durerea a fost asociată cu o scădere a calității vieții și perceperea stării de sănătate de rând cu rezultatele funcționale reduse, și respectiv un nivel mai crescut de dependență funcțională la externare [2]. De asemenea, s-a observat că durerea la pacienții post-AVC este subdiagnosticată și evaluată în mod insuficient, prin urmare, nu este tratată în timpul spitalizării, iar unul din patru participanți avea nevoi nesatisfăcute pentru tratamentul durerii pe un terment de lungă durată [2,3].…”

Section: Introducereunclassified

See 1 more Smart Citation

Pain after stroke - mechanisms, clinical manifestations and rehabilitation interventions

Melnic¹,

Plesca

Pascal

et al. 2022

BulMed

View full text Add to dashboard Cite

Introduction. Different painful syndromes and comorbidities can often occur in stroke survivors; thus, pain management remains a strong issue that interferes with the rehabilitation programs and contributes to poor functional outcomes. Painful conditions can be regarded as comorbidities or complications of stroke itself, which makes the rehabilitation more difficult. The aim of the research was to investigate the types and causes of pain after stroke and the possibilities of rehabilitation interventions for pain control. Methods: A multiple directed literature research was conducted using the key words “stroke”, “pain”, “stroke rehabilitation” and “painful comorbidities” in PubMed, Google scholar databases. Results: The most common types of pain associated with stroke to be found were: shoulder pain, complex regional pain syndrome, central post-stroke pain and headache. Usually, musculoskeletal disorders and pain related to spasticity can lead to chronic suffering, and are related to loss of function. In some cases, different causes of pain can overlap in stroke patients. Discussion: Rehabilitation interventions in stroke can be regarded as a solution or an additional treatment to painful syndromes. Physical therapy methods, movement therapy, heat and cold therapies or TENS can serve as therapeutical and rehabilitation options for shoulder pain, pain related to spasticity or musculoskeletal disorders. A multidisciplinary approach that consists of pharmacological and physical treatments is requested in most of the cases. Conclusion: Post-stroke pain is a common clinical feature, but also a very heterogeneous one, with multiple causes and characteristics. Rehabilitation methods bring new insights and can be regarded as additional instruments for pain treatment in stroke survivors.

show abstract

Use of analgesics in acute stroke patients with inability to self-report pain: a retrospective cohort study

Cited by 7 publications

References 58 publications

Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

Assessment instruments used for self-report of pain in hospitalized stroke patients with communication problems: a scoping review

Pain after stroke - mechanisms, clinical manifestations and rehabilitation interventions

Contact Info

Product

Resources

About