Associations of neuropathic pain and pain catastrophizing with rehabilitation outcomes in patients with stroke

BACKGROUND: Neuropathic pain and pain catastrophizing are common after stroke and may be associated with poorer rehabilitation outcomes. However, their independent associations with functional recovery remain insufficiently explored. OBJECTIVES: This study aimed to determine the frequency of neuropathic pain and pain catastrophizing in patients with stroke and to examine their associations with post-treatment rehabilitation outcomes. METHODS: In this prospective observational study, patients with post-stroke hemiplegia undergoing inpatient rehabilitation were evaluated at baseline and after a 4-week rehabilitation program. Functional status was assessed using the Barthel Index, Brunnstrom Staging, Modified Ashworth Scale, and Functional Ambulation Classification. Quality of life was assessed using the SF-12. Neuropathic pain and pain catastrophizing were assessed using the painDETECT questionnaire and Pain Catastrophizing Scale. Baseline-adjusted linear regression models examined whether baseline painDETECT and Pain Catastrophizing Scale scores were independently associated with post-treatment outcomes. RESULTS: Eighty patients were included. At baseline, 10 patients (12.5%) had possible neuropathic pain, 17 (21.3%) had definite neuropathic pain, and 15 (18.8%) had clinically significant pain catastrophizing. After rehabilitation, possible and definite neuropathic pain were observed in 5 (6.3%) and 8 patients (10.0%), respectively, and clinically significant pain catastrophizing in 9 patients (11.3%). Functional and pain-related outcomes improved after rehabilitation. In adjusted models, higher baseline Pain Catastrophizing Scale scores were independently associated with lower post-treatment Barthel Index and Functional Ambulation Classification scores. Baseline painDETECT scores were not independently associated with post-treatment outcomes. CONCLUSIONS: Pain catastrophizing, but not painDETECT score, was independently associated with poorer post-treatment functional independence and ambulation.