Pain in the elderly with stroke sequelae

Abstract

- Introduction:
The World Health Organization (WHO) defines stroke (CV) as a sudden onset of focal neurological signs of vascular origin that persist for more than 24 hours or cause death. It is the third leading cause of death in developed countries, responsible for approximately 10% of deaths, and its incidence increases with age.
Post-stroke pain is an underestimated and poorly managed problem, affecting 30-40% of survivors. Up to 42% report pain between 4 and 6 months, decreasing to 21% after one year. This pain can be headache, musculoskeletal (including shoulder pain), or neuropathic.
- Objective:
To describe nursing interventions for the rehabilitation of older adults with stroke sequelae who experience pain, with the aim of improving their functionality and quality of life.
- Methodology:
A search for articles (2020-2025) was conducted in ClinicalKey, Medigraphic.org.com, Elsevier, Redalyc, and SciELO. The information focused on cerebrovascular disease (CVD): definition, comorbidities, risk factors, statistics/epidemiology (Mexico, Latin America, Europe), sequelae, types and treatment of post-stroke pain, and rehabilitation.
• Study subject: An older adult with stroke sequelae receiving medical care at the "LGII" INR. Participation was formalized with informed consent.
• Materials and procedures: Data were obtained using the Daniels, Ashworth, REM, ENA, and VAS scales. Material resources: Computer, elastic bands, aromatic essences, dumbbells, pens, blood pressure monitor, stethoscope, reflex hammer, therapeutic weight, compresses, technical aids, dynamic orthosis, stopwatch, and infographics.
• Ethical considerations: Article 4 of the Political Constitution of the United Mexican States, NOM-004-SSA3-2012, NOM-015-SSA-2023, NOM-019-SSA3-2013, Decalogue of the Code of Ethics for Nurses in Mexico, and Patients' Rights.
- Results:
A male and female patient with right shoulder pain following a stroke is not receiving timely medical care.
Indicators:
• Variable measured: Pain intensity.
• Measurement tool: Visual Analog Scale (VAS).
• Indicator objective: To evaluate the effectiveness of rehabilitation nursing interventions in reducing shoulder pain. A reduction of at least 3 points on the VAS is considered a clinically significant improvement. This improvement is achieved through breathing techniques, pain management with analgesics, physical rehabilitation, heat therapy, and the use of a VAS scale.
• Use of the VAS scale: An older adult with right shoulder pain related to stroke sequelae is assessed weekly.
• VAS administration: The patient is presented with a 10-cm line with "no pain" at one end (0) and "worst pain imaginable" at the other (10).
• Indicator analysis: The decrease in the VAS is 7−4 = 3 points after 6 weeks.
- Conclusions:
Nursing interventions in rehabilitation are crucial for the management of pain (acute, chronic, somatic, neuropathic). The literature review and the case study show that early recognition and treatment of pain, measured with scales such as the VAS, significantly reduce its intensity. This improves functionality by facilitating participation in activities of daily living (ADL), promoting independence and a better quality of life.