Factors and characteristics of chronic pain in survivors of critical conditions

Abstract

This study aimed to determine the factors that affect the development of chronic pain in patients who recovered from a critical illness and to explore characteristics of pain.
 Material and methods. This study included a total of 112 patients with surgical pathology who stayed in the intensive care unit (ICU) and subsequently discharged from the hospital. Before discharge, patients were assessed using a short pain questionnaire, the PainDetect questionnaire to assess the neuropathic component of pain, and the HADS questionnaire to verify the presence of anxiety and depression. After 6 and 12 months, catanamnestic data were analyzed, and neuro-orthopedic examination and repeat testing were performed. The duration of ventilation and ICU and hospital stays were assessed as risk factors. The APACHE-II scale score and the maximum SOFA scale score were used as severity parameters of critical conditions. The maximum level of C-reactive protein (CRP) was recorded as a marker of inflammation. The Charlson comorbidity index was used to assess baseline comorbidity.
 Results. After 6 months, pain syndrome developed in 55.6% of the patients, and after 12 months, the average pain intensity was 4 points on the verbal rating scale in 59% of the patients. Neuropathic pain was diagnosed in 34% of the patients. The most frequent location of pain was the shoulder joint area, and both shoulders were affected by pain in 58.2% of the patients. In the period from 6 months to 1 year after discharge from the ICU, the risk factors for chronic pain were the duration of ventilator use, ICU stay, and CRP level. Age and gender did not affect the development of chronic pain in patients who recovered from critical illness.
 Conclusions. Chronic pain is a complication in more than half of the patients with critical illness. A third of patients with chronic pain experienced neuropathic pain, which requires a comprehensive approach to relieve pain.