Chronic pain in patients with mine-explosive wounds

In patients with gunshot wounds, chronic pain is observed in 70% of cases. One of the factors that influence such a high frequency of pain chronicity is the number of localizations of injured anatomical parts of the body – in patients with injuries in 1 or 2 anatomical parts of the body, the frequency of chronicity is 69.7%, and in patients with injuries in 3 – 71.2% of cases. Also, the presence of a neuropathic component of pain in this category of patients and its possible impact on such a high frequency of chronicity remains unexplored. Materials. The treatment of 769 patients was analyzed. The Douleur Neuropathique 4 questions were used to identify neuropathic pain. The Shapiro-Wilk, Mann-Whitney, Friedman's Bonferroni correction, and chi-square test with a continuity correction were also used. In all cases, the critical level of significance was set at 0.05. Results. Douleur Neuropathique 4 questions data indicate that all patients had a neuropathic pain component (scores range from 4 to 5). At the time of discharge at the stage of treatment in military medical clinical centers, we observed the absence of a neuropathic component of pain in some patients – these were those patients who did not have chronic pain. After 1 month – p=0.918, 3 months – 0.713, 6 months – p=0.824, and 12 months – p=0.911 observation, the data did not differentiate. Conclusions. Patients who received gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients of this category, so it may be one of the key components of such a high frequency of chronicity.

Presence of a neuropathic pain component in patients with chronic pain after gunshot wounds

Horoshko

Kuchyn²

2023

Effectiveness of pain treatment for patients with mine-blast wounds depending on the number of localizations in military mobile hospitals

Horoshko

Kuchyn

2023

Patients with gunshot wounds suffer from chronic pain in 70% of cases, and those with mine-blast wounds – in 83.3% of cases. Civilian patients, after serious injuries, in 11-40% of cases. Unfortunately, there is not enough data to study the causes of such a high frequency of pain chronicity. Therefore, the study of the results of pain treatment at the stage of treatment in military mobile hospitals may be able to reveal the reasons for such a high frequency of chronicity. Methods. The treatment of 280 patients with mine-blast wounds was analyzed. The intensity of pain was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The law of distribution differed from the normal one, the median value (Me) and interquartile range (QI-QIII) were given to present quantitative indicators, and the comparison of indicators in the two groups was performed by the Mann-Whitney test. To analyze the dynamics of indicators, the Friedman criterion for linked samples was used, and the posterior comparison was performed using the Bonferroni correction. For qualitative indicators, the absolute frequency of the trait and the relative frequency (%) are presented, and the chi-square test with the correction for continuity was used to compare the two groups. In all cases, the critical level of significance was set at 0.05. Results. The analysis of pain intensity according to the VAS, before anesthesia, upon admission to military mobile hospitals, showed that patients experienced high-intensity pain reaching 7 points. This indicates a lack of effective pain control both at the initial stage of treatment and during evacuation. After anesthesia, VAS data indicate the presence of moderate pain – 4 points. The intervals between analgesic treatments averaged 6 hours. Although the effectiveness of analgesia according to VAS was low. Conclusions. Patients with mine-blast injuries have a very high risk of chronic pain – 57.5% higher than in injured patients in civilian life. The study results point to ways to improve treatment outcomes for this category of patients. Achieving high-quality pain control at the stage of treatment in military mobile hospitals and maintaining the continuity of treatment during an evacuation can potentially reduce the incidence of pain chronicity.

Quality of Life and Pain Management in Patients After Gunshot Wounds

Horoshko

2023

Introduction. In 1948, the World Health Organization defined health as not only the absence of disease but also the presence of physical, psychological and social well-being. Quality of life is a somewhat new concept borrowed from sociology, where it is understood as the ability of an individual to function in society in accordance with his or her position and to enjoy it. A number of researchers have studied the quality of life of patients after injuries, but there are very few results in Ukraine. Given the increasing number of patients with gunshot wounds, our study aims to highlight this issue, as it will be of national importance in the long term. The aim is to study the level of quality of life in patients after gunshot wounds. Materials and methods. The treatment of 769 patients was analyzed. The level of quality of life was studied using the Chaban quality of life scale (CQLS). The groups were compared by the Mann-Whitney test and the chi-square test. Results. The CQLS diagnosis indicates that at the time of discharge from inpatient treatment, the quality of life was at a high level (76 points), but then, 1 month after discharge, it decreased to a low level (64 points) and did not change in the following months – 3, 6 and 12 months. Conclusions. The results of the study indicate that more attention should be paid to the problem of quality of life in patients after gunshot wounds and that we should strive to study this issue and identify new ways to improve the situation. In our opinion, one of the factors that affect the quality of life is the formation of chronic pain, which requires further study.