The effect of pain catastrophizing on rehabilitation outcomes in hemiplegic patients

Background: The aim of this study was to determine the presence and frequency of neuropathic pain and pain catastrophizing in stroke patients and to investigate the effects of these factors on rehabilitation outcomes. Materials and Methods: In this prospective study, stroke patients who had stroke and were admitted to hospital for rehabilitation treatment were included. Barthel Index, Brunnstrom staging, Modified Ashworth Scale, Functional Ambulation Classification, SF-12 scale was used to evaluate the clinical status of the patients, Barthel Index, Brunnstrom staging, Modified Ashworth Scale, Functional Ambulation Classification to evaluate the functionality before the treatment and after the 4-week rehabilitation program; SF-12 scale was used to evaluate the quality of life; painDETECT Pain Questionnaire was used for neuropathic pain and Pain Catastrophizing Scale was used to evaluate pain catastrophizing. Results:A total of 80 stroke patients, 37(46.25%) women and 43(53.75%) men, were included in the study. There were 10(12.5%) patients with possible neuropathic pain and 17(21.3%) patients with significant neuropathic pain before treatment. There were 15(18.8%) patients with pre-treatment pain catastrophization. There were 2(13.3%) patients with non-neuropathic pain, 2(13.3%) patients with possible neuropathic pain, and 11(73.3%) patients with significant neuropathic pain which was statistically significant (p<0.001). The number of patients with catastrophizing pain after treatment decreased to 9(11.3%), which was statistically significant(p=0.014). While there were 17 patients with neuropathic pain and 10 patients with possible neuropathic pain before treatment, these numbers decreased to 8 and 5, respectively, after rehabilitation, these changes were statistically significant(p<0.001). When the change in neuropathic pain levels according to the presence of catastrophic thinking before treatment in patients with pain was examined, the change in neuropathic pain levels in the group that did not catastrophize pain was significantly different from those who catastrophized(p<0.001). In addition, when the change in pain levels in each group was evaluated separately, this change was again found to be significant in the group without catastrophic thinking(p = 0.007), while the change in pain in the group with catastrophic thinking was not statistically significant(p = 0.172). Baseline pain catastrophizing total scores were negatively correlated with post-treatment Functional Ambulation Scale(p=0.005,rho=-0.311), mental(p<0.001,rho=-0.467) and physical(p<0.016,rho=-0.268) quality of life. Baseline pain scores were negatively correlated with post-treatment Functional Ambulation Scale (p=0.038,rho=-0.232), mental(p<0.001,rho=-0.401) and physical(p<0.007,rho=-0.302) quality of life. Conclusion:Our study found that neuropathic pain and catastrophizing behavior related to pain affected patients' rehabilitation outcomes. These findings emphasize the importance of considering the presence of neuropathic pain and pain catastrophizing and planning interventions to reduce these behaviors using a comprehensive approach. Keywords:Neuropathic Pain,Pain Catastrophizing,Stroke,Stroke Rehabilitation