Prevalence of and Demographic Differences in Central Poststroke Pain Syndrome in a Large Academic Medical Center

Central poststroke pain (CPSP) is a chronic neurological condition that results from damage to the brain's pain-processing pathways and causes hypersensitivity to pain. Despite its clinical importance, yet remains underrecognized, its estimated prevalence ranges from 8% to 35%. OBJECTIVE:This study examines the prevalence of CPSP and explores demographic and comorbidity differences among stroke survivors. METHODS: This retrospective, cross-sectional study used de-identified data from electronic health records from a large academic health center in the North Central Florida region (2014-2024). International Classification of Diseases-9 and International Classification of Diseases-10 codes were used to identify ischemic stroke, hemorrhagic stroke, and CPSP. Descriptive statistics, χ2, t test, and multivariable logistic regression were used for statistical analyses. RESULTS: Of 32,155 adult patients, only 99 (0.31%) were diagnosed with CPSP. The odds of being diagnosed with CPSP were higher in patients with ischemic stroke than hemorrhagic [adjusted odds ratio (AOR) = 2.00, 95% CI: 1.19-3.37, P = .009]. The mean age of CPSP patients was 59 years (SD = 13.1), significantly younger than those without CPSP (M = 64, P = .001), with no difference in sex distribution. Black patients (AOR = 0.47, 95% CI: 0.30-0.74, P = .001) and Hispanic patients (AOR = 3.31, 95% CI: 1.49-7.31, P = .003) both had significantly higher odds of a documented CPSP diagnosis compared with white and non-Hispanic patients. Hypertension (74.8%) was the most common comorbidity among patients with CPSP, while only atrial fibrillation was significantly less prevalent (P = .006) in the CPSP group. CONCLUSION: Our findings indicate a low prevalence of CPSP in patients who have experienced stroke. The prevalence of documented poststroke pain was substantially lower than published estimates suggest. Further investigation is needed to understand the experience of CPSP in younger, black, Hispanic, and multimorbidity populations.