Induced pain in intensive care unit: are there sex differences?

Abstract

The induced pain (procedural pain) is a short-term pain caused by a doctor or other medical staff during therapeutic or diagnostic action in foreseeable circumstances and likely to be prevented by adopted measures. Induced pain prevalence is between 43-56% for adults, 59% - for children and up to 93% - for newborns. Over 660 painful gestures were identified, with an average of 1.8 gestures per patient per day. From all studied painful gestures, intense pain and extremely intense pain was attested at 57% of patients. Scheduled treatment of postoperative pain has no influence on induced pain. So, it is imperative to ensure additional analgesic treatment. At our knowledge, the induced pain was no subject to any study in Republic of Moldova till now. Therefore, we aimed to describe incidence and pain intensity for some sources of induced pain in the intensive care unit (ICU) and to identify any gender differences. The study included 99 adult patients (M - 39 F - 60), hospitalized postoperatively in ICU. Patients completed a specifically designed questionnaire, where they noted supported painfully diagnostic or therapeutic interventions and also, the intensify of pain (assessed by visual-rating score VRS 0-10). Statistical tests used: t-Student, СЫ2 with Yates correction. One p<0.05 was considered statistically significant. Both groups (M vs. F) were comparable according to level of education, ASA score, and range of interventions. Instead, F group were significantly older (61.7 ± 14.7 [95CI: 57,9-65,4] vs 47.1 ± 15.0 [95CI: 42,2-52,0] years, p<0.0001). Spectrum and incidence of induced pain sources were recorded (M vs F): intravenous injection (97-98%), intramuscular injection (87-95%), bladder catheterization (79-88%), dressings (79-83%), wound drains (59-60%), neuraxial puncture (49-48 %), peripheral venous line (51-48%), tracheal tube (36­ 47%), naso-gastric tube (33-30%), arterial puncture (18-23%) with no significant differences between groups. The only exception: subclavian vein catheterization was more common in women because of more advanced age of patients in group (20% vs 10%, pO.OOOl). As very painful (SVA>5) were reported: arterial puncture (in 50% cases), subclavian vein catheterization (22%), neuraxial puncture (13%), nasogastric tube (12%), bladder catheterization (12%), peripheral venous line (7%), and other interventions (<5%). The conclusions are: 1) induced pain in intensive care unit has an extremely high incidence, intensity and variety of sources. 2) Generally were not identified gender differences in the spectrum, frequency and intensity of induced pain.