Occurrence peculiarities of different phenotypes of post-stroke pain syndrome (results of a follow-up study)

Objective. To clarify the peculiarities of occurrence, characteristics and associated symptoms of various phenotypes of post-stroke pain syndrome (PSPS) in a follow-up survey.

Materials and methods. A retrospective cohort study was conducted based on an analysis of medical records followed by prospective telephone interviews. A total of 300 records of impatiens treated on account of acute cerebrovascular accident (ACVA) from 2018 till 2020 inclusive were randomly selected from the archives of the Stroke Neurology Department of the Gomel University Clinic – Regional Hospital for Veterans of the Great Patriotic War. There were 211 men, 89 women, average age is 57.7±8.5 years old. A structured survey included questions aimed at assessing the following aspects of PSPS: localization, time of onset relative to the moment of ACVA, duration and nature of pain. Data on the presence and severity of spasticity (hypermyotonia), concomitant sleep disorders, as well as the analgesic and pathogenetic therapy received by the patients were recorded additionally. Statistical processing was performed using the software package “Statistica 12.0” (StatSoft, Inc.).

Results. Analysis of medical records revealed the presence of PSPS in the acute period of the disease in 97 patients (32,3% of the total cohort). A significant correlation was established between the occurrence of pain syndrome in the acute period and the type of the past ACVA (r=0,42; p<0,05). The incidence of PSPS was significantly higher in the ICH group compared to the IGM group: 43 cases (71,7%) versus 54 cases (22,5%), respectively (χ²=21,3; p<0,001). During the follow-up survey, pain syndrome was verified in 178 patients (59,3%) in 1–3 years after the stroke. The prevalence of PSPS in the late period significantly exceeded that in the acute period (χ²=44,1; p<0,001). Isolated pain syndrome of one type was recorded in 96 patients (53,9% of the group with PSPS). Its structure was distributed as follows: headache – 52 patients (29,2%); shoulder pain – 29 patients (16,3%); musculoskeletal pain – 8 patients (4,5%); central pain in the extremities – 7 patients (3,9%). Combined forms of PSPS, including several types of pain, were observed in 82 patients (46,1%): combination of 2 types of pain – 66 patients (37,1%); combination of 3 types of pain – 12 patients (6,7%); combination of 4 types of pain – 4 patients (2,3%).

Conclusion. PSPS is a clinically heterogeneous, often comorbid condition requiring a differentiated approach to diagnosis and treatment. The data obtained on the characteristics of PSPS phenotypes, their temporal dynamics, and associated symptoms can serve as the basis for developing personalized algorithms for post-stroke patient care aimed at improving functional outcomes and quality of life.

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