Patients help researchers better understand post-stroke pain.
Stroke patients have a lot of challenges, such as trying to relearn lost motor skills, dealing with paralysis, and finding new ways to communicate with speech impairment. But there’s another challenge that often presents long after a stroke, and is poorly understood: pain.
Vancouver Coastal Health Research Institute investigators are trying to get a better picture of post-stroke pain and they’re asking patients to help.
“We’re looking at the pain we see most often in our clinic: headache and joint pain,” says Dr. Field. “There’s not a lot in the literature about these two types of pain. What we do know is that if pain isn’t effectively treated, it’s hard for patients to make gains in other areas.” For example, if a patient has joint pain, they are less likely to exercise as much as they should for rehabilitation. This can lead to muscle loss and even cognitive decline.
Dr. Field says there are extra challenges in quantifying pain for stroke patients, especially those who have trouble with language. Special techniques have to be used to gauge the kind of pain experienced by someone who can’t communicate effectively. Post-stroke pain is also often underreported. And since it sometimes occurs months after stroke, doctors don’t always link pain back to the stroke.
Dr. Josh Lai, a second-year resident at VGH, is leading the study, under Dr. Field’s supervision and with the help of research assistant Lauren Quong.
Dr. Lai says so many questions remain about post-stroke pain: Why do some patients get pain and others don’t? Are patients who had frequent headaches prior to stroke more susceptible to a post-stroke headache? Does the type of stroke influence the type and severity of post-stroke pain. “There’s so much we don’t know for sure,” says Dr. Lai. “We hear things anecdotally, but we need to quantify them.”
Researchers are also keen to learn more about the impact pain has on depression and fatigue in stroke patients. “It’s all connected,” says Dr. Lai.
Better understanding, better patient care
The research team hopes to gain answers through patient questionnaires, which will focus on headaches and joint pain. This study will be the pilot phase of a larger project. One hundred patients will complete the surveys by this fall, and then Drs. Field and Lai would like to build on the data and expand the survey.
We want to use our results to provide a more accurate prognosis for our patients,“ says Dr. Field. “We want to be able to answer their questions. How long will their pain last? Will the intensity of pain persist?”
Being able to determine pain prevalence will also help guide treatment and care decisions. For example, pre-emptive early physiotherapy may be useful, but to justify that kind of intervention, researchers need a more accurate picture of prevalence. For Drs. Field and Lai, the ultimate goal of surveying their patients is to improve the quality of life. With 1,500 patients coming through the clinic each year there is a wealth of information researchers can gather by just asking the right questions.
