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Living with Long-Term Pain after a Stroke
Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to classify and describe long-term pain two years after a stroke and to describe the experiences of pain, and the consequences it has on the persons’ lives. The studies were conducted from a multidimensional perspective on pain, combining quantitative and qualitative methods. Three types of long-term pain were classified and described among the 43 participants included, aged 33-82 years. These were central post-stroke pain, nociceptive, mainly shoulder pain, and tension-type headache. Pain onset, within one to six months in most of the cases was after discharge from the hospital. Continuous pain or pain almost every day was reported by nearly two-thirds. The pain was mostly described as troublesome, annoying and tiring in all pain groups. The rating of pain intensity revealed individual differences among the participants within the pain groups. In addition to long-term pain, the participants suffered several impairments and nearly half of them were dependent on others, and two-thirds on assistive devices. Several coping strategies were described, most often problem-focused. Their health-related quality of life was decreased, mostly related to their long-term pain and physical impairments. Their experiences of caring revealed the need of improvements in knowledge about longterm pain, attention and understanding among the professionals, and continuity in the contacts.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. , 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 827
Keyword [en]
stroke, central pain, chronic pain, neuropathic pain, nociceptive pain, shoulder, pain, tension-type headache, pain assessment, disability, activities of daily living, coping, health-related quality of life, mood, caring
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5228ISBN: 91-7373-518-3 (print)OAI: oai:DiVA.org:liu-5228DiVA: diva2:21206
Public defence
2003-12-12, Aulan, Örbero universitet, Örebro, 13:00 (English)
Opponent
Supervisors
Note
On the day of the public defence the status of article III was: Accepted for publication and the status of article IV was: In press.Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2012-01-25Bibliographically approved
List of papers
1. Long-term pain conditions after a stroke
Open this publication in new window or tab >>Long-term pain conditions after a stroke
2002 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 34, no 4, 165-170 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to classify and describe the characteristics of different long-term pain conditions after a stroke by clinical examination and pain assessment using the Pain-O-Meter and a Pain questionnaire. Pain was classified as central post-stroke pain (n = 15), nociceptive pain (n = 18), and tension-type headache (n = 10). In 65%, pain onset was within 1-6 months and the pain intensity revealed individual differences. Many pain descriptors was common, some were discriminating as burning in central and cramping in nociceptive pain, and pressing and worrying in headache. More than half with central or nociceptive pain had continuous or almost continuous pain. Cold was the factor mostly increasing the pain in central, physical movements in nociceptive pain, and stress and anxiety in headache. More than one-third had no pain treatment and two-thirds of those with central pain had no or inadequate prescribed pain treatment. The clinical findings support the classification of pain and describe discriminating and common pain characteristics in pain conditions after a stroke.

Keyword
Pain, Pain Measurement, Stroke, Central Poststroke Pain, Cpsp, Shoulder Pain, Headache
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13718 (URN)10.1080/16501970213237 (DOI)
Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2009-06-08
2. Disability after a stroke and the influence of longterm pain on everyday life
Open this publication in new window or tab >>Disability after a stroke and the influence of longterm pain on everyday life
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 16, no 3, 302-310 p.Article in journal (Refereed) Published
Abstract [en]

Pain after a stroke is a symptom often forgotten, unnoticed although it is reported to be a great problem in care. The aim of this study was to describe disability after a stroke and how long-term pain influences everyday life according to the Multidimensional Pain Inventory – Swedish language version (MPI-S) and to test the reliability of this instrument. Forty-three persons were investigated 2 years after the stroke incident: 15 with central post-stroke pain (CPSP), 18 with nociceptive pain mainly in the shoulder and 10 with tension-type headache. Data collection was performed through the MPI-S and a questionnaire regarding assistive devices, also structured interviews based on the Activities of Daily Living (ADL) staircase and the Self-report impairment questionnaire. The results show that the persons suffered moderate to severe pain. Almost half were dependent in ADL. The most often reported impairments and use of assistive devices concerned mobility and/or motion. This was most frequent in persons with nociceptive pain. There were significant differences in persons with central pain and nociceptive pain compared with tension-type headache with regard to mobility- and/or motion-related activities. No statistical differences emerged between age, gender, different types of pain and the MPI-S scales, nor any significant differences in degree of pain as between different types of pain according to the Self-report impairment questionnaire. The reliability analysis of the MPI-S shows good homogeneity in all scales except Interference, Life Control and Affective Distress. This is the first study with MPI-S on mainly older persons and on stroke patients, thus further research is needed on this instrument as well as on which specific activities evoke the pain. This is in order to offer adequate treatment, care and support to persons with pain after a stroke.

Keyword
disability, impairment, stroke, chronic pain, activities of daily living, the Multidimensional Pain Inventory, Swedish language version (MPI-S), spouse, family
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13719 (URN)10.1046/j.1471-6712.2002.00090.x (DOI)
Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2009-06-08
3. Coping with long-term pain after a stroke
Open this publication in new window or tab >>Coping with long-term pain after a stroke
2004 (English)In: Journal of Pain Symptom and Management, ISSN 0885-3924, Vol. 27, no 3, 215-225 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this qualitative study was to describe pain, coping strategies, and experienced outcome of coping with long-term pain conditions after a stroke. Forty-three participants were interviewed: 15 with central post-stroke pain (CPSP), 18 with nociceptive pain, and 10 with tension-type headache. Analysis of the data was by content analysis. Pain-related problems described were incomprehensibility regarding the pain, disturbed sleep, fatigue, diminished capacity, mood changes, and stress in relationships. Different coping strategies were used; the most common were making the pain comprehensible, planning of activities, taking medications, communicating, and distractions. Changing body position, making comparison, and enduring the pain were common in central or nociceptive pain, rest and relaxation in tension-type headache. Communicating their pain gave a feeling of perplexity and resignation. Satisfaction was reported in the cases of consideration shown by others. Pain after a stroke requires specialized knowledge in order to understand the patient's experiences and to enhance coping.

Keyword
Coping, central post-stroke pain (CPSP), nociceptive pain, headache, stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13720 (URN)10.1016/j.jpainsymman.2003.07.006 (DOI)
Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2009-08-21
4. Health-related quality of life in persons with long-term pain after a stroke
Open this publication in new window or tab >>Health-related quality of life in persons with long-term pain after a stroke
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, Vol. 13, no 4, 497-505 p.Article in journal (Refereed) Published
Abstract [en]

Background. No study has, to our knowledge, previously been published on health-related quality of life (HRQoL) in a group suffering from long-term pain after a stroke.

Aim. The aim of the present study was to describe HRQoL in persons with long-term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status.

Design. This study has a design combining qualitative and quantitative methods.

Methods. Forty three participants suffering from long-term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self-report questionnaires, SF-36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used.

Results. The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF-36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF-36. The men had more decreased vitality than the women.

Conclusion. The results show, that the participants in this study have a lower HRQoL due to their long-term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care.

Relevance to clinical practice. Awareness and understanding of the patients' perceptions and transitions with regard to their life situation and suffering from long-term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons.

Keyword
chronic pain, health, mood, quality of life, stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13721 (URN)10.1046/j.1365-2702.2003.00815.x (DOI)
Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2009-08-21
5. Caring and uncaring experiences as narrated by persons with long-term pain after a stroke
Open this publication in new window or tab >>Caring and uncaring experiences as narrated by persons with long-term pain after a stroke
2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, 41-47 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe how persons with long-term pain after a stroke experience their care. The study is part of a larger research project concerning a group persons suffering from long-term pain after a stroke. Qualitative interviews were performed with 43 persons suffering from central poststroke pain, nociceptive pain or tension-type headache after their stroke incident. Content congruence emerged among the narratives (n = 43), and therefore the most information-rich ones (n = 23) were selected for deeper investigation by means of qualitative content analysis. The results reveal the patients' need for being respected, understood and supported, also for being given adequate time and information. Accessibility and continuity in the professional contacts and with regard to medical and physical treatment was emphasized. The participants' narratives highlight the importance of the professionals having knowledge of pain and pain management.

Keyword
caring, chronic pain, content analysis, neuropathic pain, nociceptive pain, headache, stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13722 (URN)10.1111/j.1471-6712.2007.00449.x (DOI)
Available from: 2004-01-18 Created: 2004-01-18 Last updated: 2014-01-20

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