Associations of neuropathic pain and pain catastrophizing with rehabilitation outcomes in patients with stroke.

BACKGROUND

Neuropathic pain and pain catastrophizing are common after stroke and may be associated with poorer rehabilitation outcomes. However, their independent associations with functional recovery remain insufficiently explored.

OBJECTIVES

This study aimed to determine the frequency of neuropathic pain and pain catastrophizing in patients with stroke and to examine their associations with post-treatment rehabilitation outcomes.

METHODS

In this prospective observational study, patients with post-stroke hemiplegia undergoing inpatient rehabilitation were evaluated at baseline and after a 4-week rehabilitation program. Functional status was assessed using the Barthel Index, Brunnstrom Staging, Modified Ashworth Scale, and Functional Ambulation Classification. Quality of life was assessed using the SF-12. Neuropathic pain and pain catastrophizing were assessed using the painDETECT questionnaire and Pain Catastrophizing Scale. Baseline-adjusted linear regression models examined whether baseline painDETECT and Pain Catastrophizing Scale scores were independently associated with post-treatment outcomes.

RESULTS

Eighty patients were included. At baseline, 10 patients (12.5%) had possible neuropathic pain, 17 (21.3%) had definite neuropathic pain, and 15 (18.8%) had clinically significant pain catastrophizing. After rehabilitation, possible and definite neuropathic pain were observed in 5 (6.3%) and 8 patients (10.0%), respectively, and clinically significant pain catastrophizing in 9 patients (11.3%). Functional and pain-related outcomes improved after rehabilitation. In adjusted models, higher baseline Pain Catastrophizing Scale scores were independently associated with lower post-treatment Barthel Index and Functional Ambulation Classification scores. Baseline painDETECT scores were not independently associated with post-treatment outcomes.

CONCLUSIONS

Pain catastrophizing, but not painDETECT score, was independently associated with poorer post-treatment functional independence and ambulation.