title: Chronic pain syndromes after ischemic stroke: PRoFESS trial.
abstract: OBJECTIVE
  Chronic pain syndromes are reported to be common after stroke, but most previous epidemiological studies have generally included small cohorts of patients with relatively short-term follow-up. In a large cohort with ischemic stroke (Prevention Regimen for Effectively avoiding Second Stroke [PRoFESS] trial), we determined the prevalence, risk factors, and clinical consequence of new poststroke pain syndromes.
  
  
  METHODS
  Within the PRoFESS trial (mean follow-up 2.5 years), a standardized chronic pain questionnaire was administered (at the penultimate follow-up visit) to all participants who reported chronic pain since their stroke and did not have a history of chronic pain before their index stroke. Multivariable logistic regression analyses were used to determine risk factors for poststroke pain (and pain subtypes), and the association between poststroke pain and cognitive (≥ 3 reduction in Mini-Mental State Examination score) and functional decline (≥ 1 increase in m-Rankin).
  
  
  RESULTS
  In total, 15 754 participants were included; of which 1665 participants (10.6%) reported new chronic poststroke pain, and included 431 participants (2.7%) with central poststroke pain, 238 (1.5%) with peripheral neuropathic pain, 208 (1.3%) with pain from spasticity, and 136 participants (0.9%) with pain from shoulder subluxation. More than 1 pain subtype was reported in 86 participants (0.6%). Predictors of poststroke pain included increased stroke severity, female sex, alcohol intake, statin use, depressive symptoms, diabetes mellitus, antithrombotic regimen, and peripheral vascular disease. A new chronic pain syndrome was associated with greater dependence (odds ratio, 2.16; 95% confidence interval, 1.82-2.56). Peripheral neuropathy and pain from spasticity/shoulder subluxation were associated with cognitive decline.
  
  
  CONCLUSIONS
  Chronic pain syndromes are common after ischemic stroke and are associated with increased functional dependence and cognitive decline.
authors.affiliation: Population Health Research Institute, DBCVS Research Institute, McMaster University, 3rd Floor, 237 Barton St E, Hamilton, Ontario, L8L 2X2, Canada. odonnm@mcmaster.ca
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Donnell
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Akbar A
authors.initials: AA
authors.lastname: Panju
authors.forename: Richard
authors.initials: R
authors.lastname: Vinisko
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000523:psychology