Association of Poststroke Pain Prevalence and Subtypes With Lesion Sites in Ischemic and Hemorrhagic Stroke: A Cross-Sectional Study.

Background Poststroke pain (PSP) is an underrecognized but clinically significant complication of stroke that adversely affects rehabilitation, mood, and quality of life. Evidence from Bangladesh and similar low- and middle-income settings examining PSP subtype frequency in relation to lesion characteristics remains limited. This study aimed to determine the prevalence and subtypes of PSP and to evaluate their associations with lesion site, lesion side, and stroke type among patients with ischemic and hemorrhagic stroke in Bangladesh. Methods This hospital-based cross-sectional study was conducted among 250 adult stroke patients who were recruited via purposive sampling and were attending the stroke clinic of Dhaka Medical College Hospital, Bangladesh, between two months and two years after the index stroke event, over a 24-month period between March 2021 and February 2023. Sociodemographic, clinical, and biochemical data were collected using a structured case record form. Pain intensity was assessed using the visual analog scale, and stroke type, lesion side, and lesion site were determined from computed tomography (CT) or magnetic resonance imaging (MRI) reports. Patients were evaluated for four PSP subtypes: central poststroke pain (CPSP), hemiplegic shoulder pain (HSP), contracture-associated pain (CAP), and poststroke headache. Multivariable binary logistic regression was used to assess factors independently associated with prevalent PSP; estimates are reported as adjusted prevalence odds ratios (AORs). Results PSP was identified in 104 (41.60%) patients. Among these 104 patients, poststroke headache was the most common subtype, 44 (42.30%), followed by CAP, 32 (30.80%); HSP, 25 (24.00%); and CPSP, 13 (12.50%). The corresponding prevalence rates in the total cohort were 17.60%, 12.80%, 10.00%, and 5.20%, respectively, and the subtypes were not mutually exclusive. CPSP and CAP were associated with right-sided lesions (p = 0.002 and p < 0.001, respectively), whereas headache was associated with the lesion site (p < 0.001). The factors independently associated with increased odds of prevalent PSP were low educational status (AOR = 2.305), right-sided lesions (AOR = 2.648), triglyceride level per 1 mg/dL (AOR = 1.015), and limited muscle power (AOR = 2.858); serum creatinine per 1 mg/dL was inversely associated (AOR = 0.263). Conclusions PSP was present in a substantial proportion of stroke survivors, with headache being the most common subtype. Lesion side, lesion site, educational status, muscle power, and biochemical markers were significantly associated with PSP, indicating a heterogeneous, subtype-specific phenomenon. Larger multicenter, longitudinal studies are needed to confirm these associations.