Stroke：缺血性卒中后慢性疼痛综合征常见

　　一项多国联合研究表明，缺血性卒中后慢性疼痛综合征较为常见，并且与功能依赖增加和认知减退相关。论文于4月4日在线发表于《卒中》（Stroke）。

　　此项研究从平均随访2.5年的PRoFESS试验中共纳入15754例受试者。利用标准化慢性疼痛调查问卷对卒中后报告慢性疼痛并且索引卒中前无慢性疼痛病史的所有受试者加以评估。利用多变量Logistic回归分析确定卒中后疼痛和疼痛亚型的危险因素，以及卒中后疼痛与认知和功能减退的相关性。

　　结果显示，共有1665例（10.6%）受试者报告新发慢性卒中后疼痛，其中包括431例（2.7%）中枢性卒中后疼痛，238例（1.5%）周围神经性疼痛，208例（1.3%）痉挛状态所致疼痛，和136例（0.9%）肩不全脱位所致疼痛。86例受试者报告一种亚型以上疼痛（0.6%）。卒中后疼痛的预测因素包括卒中严重度增加、女性、饮酒、他汀类应用、抑郁症状、糖尿病、抗血栓治疗和周围血管病。新发慢性疼痛综合征与依赖性增高相关（比值比2.16）。周围神经病和痉挛状态/肩不全脱位所致疼痛与认知减退相关。

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Chronic Pain Syndromes After Ischemic Stroke
Background and Purpose
Chronic pain syndromes are reported to be common after stroke, but most previous epidemiological studies have generally included small cohorts of patients with relatively short-term follow-up. In a large cohort with ischemic stroke (Prevention Regimen for Effectively avoiding Second Stroke [PRoFESS] trial), we determined the prevalence, risk factors, and clinical consequence of new poststroke pain syndromes.
Methods
Within the PRoFESS trial (mean follow-up 2.5 years), a standardized chronic pain questionnaire was administered (at the penultimate follow-up visit) to all participants who reported chronic pain since their stroke and did not have a history of chronic pain before their index stroke. Multivariable logistic regression analyses were used to determine risk factors for poststroke pain (and pain subtypes), and the association between poststroke pain and cognitive (≥3 reduction in Mini-Mental State Examination score) and functional decline (≥1 increase in m-Rankin).
Results
In total, 15 754 participants were included; of which 1665 participants (10.6%) reported new chronic poststroke pain, and included 431 participants (2.7%) with central poststroke pain, 238 (1.5%) with peripheral neuropathic pain, 208 (1.3%) with pain from spasticity, and 136 participants (0.9%) with pain from shoulder subluxation. More than 1 pain subtype was reported in 86 participants (0.6%). Predictors of poststroke pain included increased stroke severity, female sex, alcohol intake, statin use, depressive symptoms, diabetes mellitus, antithrombotic regimen, and peripheral vascular disease. A new chronic pain syndrome was associated with greater dependence (odds ratio, 2.16; 95% confidence interval, 1.82–2.56). Peripheral neuropathy and pain from spasticity/shoulder subluxation were associated with cognitive decline.
Conclusions
Chronic pain syndromes are common after ischemic stroke and are associated with increased functional dependence and cognitive decline.