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

Abstract

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.