Pain and pain assessment in stroke patients with aphasia: a systematic review

ABSTRACT

Background: Persons with aphasia (PWA) after stroke are less able or unable to communicate about their pain due to language, speech and/or cognitive impairment. Most commonly pain rating scales are used for the assessment of pain in PWA, which could not be applied to any patient aphasia because of their inability to communicate verbally their pain.

Aims: This review aims to investigate the prevalence and incidence of pain in PWA after stroke, establish which pain assessment instruments are used, and examine whether they are feasible, valid and reliable.

Methods & Procedures: A systematic literature search was made to identify studies on pain and pain assessment in PWA and persons without aphasia after stroke, or in patients with right and left hemispheric stroke. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used to evaluate the methodological quality of the studies and the properties of the measurement scales used.

Outcomes & Results: The search yielded 10 articles. The vertical, mechanical and horizontal Visual Analogue Scale, Faces Pain Scale, Verbal Rating Scale, Numeric Rating Scale, categorical site-of-pain scale, and a pictorial scale of pain intensity were used to assess pain, as were the Short-Form 36 Health Survey and the Dartmouth COOP Charts Quality of Life Scales that each have one pain item. Prevalence of pain in PWA after stroke was reported in two studies and ranged from 43.8–87.5%. Most studies described pain assessment in PWA after stroke with mild-to-moderate aphasia, while patients with severe aphasia were excluded. Various pain assessment tools were used but their feasibility, validity and reliability were generally of low methodological quality.

Conclusions: A feasible, reliable and valid instrument is not available for PWA after stroke.

KEYWORDS:

• Stroke
• stroke care
• aphasia
• pain
• assessment
• quality of life

Acknowledgments

The authors declare that there are no conflicts of interest in relation to this article.

The authors thank Claudia Pees, and the Walaeus Library of Leiden University Medical Center, for their help in developing the search strategies. This work was supported by Topaz Leiden and Leiden University Medical Center.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary Material

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Additional information

Funding

This study was financially supported by Topaz, Leiden and Leiden University Medical Center, the Netherlands.