Upper extremity pain associated with poor functional recovery post-stroke

by Paary Balakumar, Alex Chan

Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. A third of stroke survivors experienced upper extremity pain, which was associated with poor arm functional recovery at 12 months post-stroke

Evidence Rating Level: 2 (Good)

Upper extremity pain is common post-stroke and may impede motor recovery, yet its progression and impact on long-term functional outcomes remain poorly understood. This prospective study from the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) followed 122 first-ever stroke patients with impaired upper limb function over 12 months, using repeated assessments with the Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test (ARAT). Latent class analysis identified two distinct pain trajectories: stable low pain (64%) and increasing pain (36%). Patients in the increasing pain group had more severe motor, sensory, and cognitive impairments, limited range of motion, and higher stroke severity at baseline. Pain in this group rose significantly between 10 days and 3 months post-stroke before partially declining, whereas pain remained minimal in the stable group. Importantly, increasing pain was independently associated with poor functional arm recovery at 12 months (adjusted OR = 4.99; 95% CI 1.53–16.30; p = 0.008), even after accounting for stroke severity. These findings suggest that early identification of individuals on an increasing pain trajectory, particularly those with atrial fibrillation, dependency, or spasticity—could guide targeted interventions. Effective pain management in the early subacute phase may be critical for optimizing upper limb recovery. Further research should explore the underlying mechanisms of post-stroke pain and the impact of tailored rehabilitation strategies on long-term function.

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