From the Departments of Neurology (C.D.S., P.K.P., A.S., S.A., J.H.S.), Anesthesiology (K.M.K., M.C.B.), Neuroscience Services (M.E.H.), and Psychology (C.C.), University of Kentucky, Lexington.
Neurology. 2018 Aug 28;91(9):e793-e799. doi: 10.1212/WNL.0000000000006081. Epub 2018 Aug 1.
To evaluate an observational-behavioral pain tool among individuals with acute poststroke aphasia.
We performed a randomized, double-blind, controlled study of experimental pain assessment among 36 adult patients with acute poststroke aphasia. Patients were administered 3 levels of mechanical pain, including placebo. The behavioral responses were video recorded and then evaluated by 3 neurology nurses using the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC-II). Pain-specific facial action units were quantified with FaceReader version 6.1.
Median PACSLAC-II ratings for 0-, 2-, and 4.5-lb weight stimuli were 2 (0, 3), 1 (0, 3), and 2 (1, 5), respectively. Overall, differences were not detected ( = 0.06). Pairwise comparisons with the Wilcoxon method demonstrated significance in differentiating PACSLAC-II ratings of patients experiencing the 4.5-lb stimulus vs either the 2-lb weight ( = 0.03) or placebo ( = 0.05). Overall interrater reliability by the Cronbach α was strong at 0.87, 0.94, and 0.96 for weights of 0, 2, and 4.5 lb, respectively. Pain-specific facial activation and negative valence were observed similarly in placebo and experimental pain groups.
Among our cohort with acute poststroke aphasia, the PACSLAC-II was not able to overall differentiate patients experiencing experimental mechanical pain, although differences in those experiencing the strongest pain stimulus were significant. The detection of pain-specific facial activation and negative valence in the placebo group indicates that pain and distress are unmet needs among stroke patients who are unable to verbally communicate.
评估急性脑卒中后失语症个体的观察行为疼痛工具。
我们对 36 名急性脑卒中后失语症成年患者进行了实验性疼痛评估的随机、双盲、对照研究。患者接受了 3 个级别的机械疼痛刺激，包括安慰剂。行为反应被录像记录，然后由 3 名神经科护士使用有限沟通能力老年人疼痛评估检查表（PACSLAC-II）进行评估。使用 FaceReader 版本 6.1 对疼痛特异性面部动作单位进行量化。
0、2 和 4.5 磅重量刺激的中位数 PACSLAC-II 评分分别为 2（0，3）、1（0，3）和 2（1，5）。总体而言，差异不显著（ = 0.06）。Wilcoxon 方法的两两比较显示，4.5 磅刺激组的 PACSLAC-II 评分与 2 磅重量组（ = 0.03）或安慰剂组（ = 0.05）之间存在显著差异。Cronbach α 总体评分的可靠性分别为 0.87、0.94 和 0.96，用于 0、2 和 4.5 磅的重量。在安慰剂和实验性疼痛组中，观察到疼痛特异性面部激活和负性效价相似。
在我们的急性脑卒中后失语症队列中，PACSLAC-II 总体上不能区分经历实验性机械疼痛的患者，尽管经历最强疼痛刺激的患者之间存在差异。在安慰剂组中检测到疼痛特异性面部激活和负性效价表明，无法言语交流的脑卒中患者存在疼痛和痛苦等未满足的需求。
