Expressions of Pain and Spasticity in People With Stroke.

Abstract

Background: Pain and spasticity are prevalent poststroke symptoms that frequently co-occur. The coexistence of spasticity and pain in patients with neurological injury can be attributed to maladaptive neuronal changes within the central nervous system. This secondary analysis aimed to explore the patterns, descriptors, and temporal trajectories of pain as they relate to spasticity experiences in people with stroke.

Methods: A secondary analysis was conducted on data acquired from a sample of 22 people with stroke. Data included longitudinal numerical ratings and expressions of pain and spasticity from admission to the rehabilitation unit to 1-month follow-up, alongside qualitative descriptors of these sensations.

Results: Graphical analysis revealed that spasticity scores generally remained higher than or equal to pain scores, acting as the primary physical driver. Pain trajectories exhibited an overall upward linear trend despite daily fluctuations. Participants used distinct descriptors for each symptom, though "heaviness" and "numbness" emerged as common overlapping terms, indicating sensory blurring. The intensity of pain reported on the evening of the first admission day appears to set the subsequent pain trajectory; participants with lower initial evening pain maintained consistently lower levels throughout the study period. Notably, while 100% of participants were prescribed acetaminophen, only 30% received antispasticity medication baclofen, despite high spasticity ratings (levels 8-10).

Conclusion: Poststroke pain is inextricably linked to spasticity, with the latter serving as a foundational trigger. The commingling nature of these symptoms and the identified temporal surges suggest that clinical management should prioritize early antispasticity interventions. Neuroscience nurses play a vital role in identifying these trajectories early to prevent chronic symptom escalation.