Novel insights into stroke pain beliefs and perceptions

ABSTRACT

Background

Chronic pain is common following stroke, yet its characteristics are poorly understood.

Objectives

To characterize the beliefs and perceptions of people with stroke who experience chronic pain and compare these to a non-stroke population with chronic pain.

Method

An online survey of the Pain Beliefs and Perceptions Inventory for stroke and non-stroke individuals with chronic pain. Pain beliefs and perceptions, including perceived causes of pain, were compared across the two groups.

Results

A total of 223 participants completed all questions. The stroke group (N = 106) reported significantly higher pain intensities (p = <0.001) than the non-stroke group (N = 117). In addition, they identified the stroke as the primary cause of their pain, whereas the non-stroke group identified a body injury as the primary cause. When compared to the non-stroke group, people with stroke were more likely to report their pain as being constant (p = <0.001), demonstrate a lack of understanding regarding cause(s) of their pain (p = <0.001), believe less that their actions contribute to their pain (p = <0.001), and have greater belief that their pain is permanent (p = <0.001).

Conclusion

These findings emphasize differences in the beliefs and perceptions associated with pain after stroke, supporting the value of targeted attention from research and therapy perspectives. Significant differences in the pain experienced by stroke and non-stroke groups may reflect a poor understanding of chronic pain following stroke. Future educational programs for stroke survivors should be tailored. Targets for future educational interventions are identified and include causes of pain, an understanding of its behavior and potential for improved prognosis.

KEYWORDS:

• Pain
• stroke
• chronic pain
• persistent pain
• education
• pain beliefs
• pain beliefs and perceptions inventory

Authors Contribution

BSH, DSB, and LMC designed the study and interpreted the results. BSH conducted data collection and statistical analysis. BSH wrote the protocol and the first draft. All authors reviewed the first draft of the paper, gave critical revision of manuscript drafts, and approved the final edition of the manuscript.

Ethics approval

The study protocol was approved by the Human Research Ethics Committee of the University of Melbourne and the University Human Ethics Committee of La Trobe University, both in Melbourne, Australia.

Additional information

Funding

Funding for software development and website hosting for the study was provided by the Neuro-Orthopaedic Institute. We acknowledge support from the James S McDonnell Foundation 21^st Century Science Initiative in Cognitive Rehabilitation – Collaborative Award (#220020413); NHMRC project grant [GNT1022694]; an Australian Research Council Future Fellowship [#FT0992299] and NHMRC Career Development Award [#307905] awarded to LMC; a Florey Institute of Neuroscience and Mental Health top up scholarship awarded to BSH; and the Victorian Government’s Operational Infrastructure Support Program. This research is supported by an Australian Government Research Training Program (RTP) Scholarship.