Incidence and Management of Acute Pain in Trauma Patients in a Large Trauma Center
Sarasate Eiamtanasate¹, Passorn Ratatanaphruthakul¹, Sirikan Duangburong¹, Pranee Rushatamukayanunt¹
Affiliation : ¹ Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective: Trauma is a major cause of acute and intense pain. Inadequate pain control can lead to chronic pain that lessens the quality of life of the patients. The main objective of the present study was to identify the incidence of moderate to severe pain in trauma patients. Moreover, the incidence of neuropathic pain and the factors affecting the pain severity were also identified.
Materials and Methods: A prospective descriptive study was conducted in 150 trauma-related patients admitted to the trauma ward at Siriraj Hospital. The patients’ demographic data, pain score at hospital arrival, admission, and every four hours until discharged, time to first analgesia, and type of analgesia were recorded. Neuropathic pain was evaluated by clinical diagnosis together with the scores from the DN4 and painDETECT questionnaires. The information was analyzed using descriptive study statistics.
Results: One hundred fifty patients were analyzed. The incidences of moderate to severe pain on arrival at the trauma unit and at admission were 72.7% and 65.3%, respectively. The incidence of neuropathic pain was 15.3%. Neuropathic pain and multiple injuries were not significantly related to pain severity. In response to pain management, 71 patients (47.3%) had an improved pain score, and the median (IQR) pain score decreased from 7 (3 to 10) to 5 (2 to 8) (p<0.001). Among all the patients, 46.0% were treated with multimodal analgesia. The time to first analgesia for the severe pain patients was four hours (2.0 to 7.0) after arrival and two hours (0.8 to 6.0) after admission.
Conclusion: Most of the trauma patients experienced moderate to severe pain irrespective of the degree of their injuries. Neuropathic pain was found in the acute phase of traumatic pain. Pain management remains a problem that needs more attention and better pain management strategies are needed in trauma settings.
Received 28 February 2024 | Revised 3 April 2024 | Accepted 5 April 2024
DOI: 10.35755/jmedassocthai.2024.5.13990
Keywords : Trauma; Acute pain; Neuropathic pain; Pain management; Multimodal analgesia
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