Evaluating pain management in the Gaza Strip's conflict-affected hospitals: a prospective observational study

Pain is one of the most distressing symptoms for trauma patients and serves as a cornerstone of acute trauma care. The healthcare system in the Gaza Strip has been devastated by the violent war that erupted in October 2023, further worsening the shortages and limitations it already experienced due to repeated assaults and a prolonged siege. The war-wounded are thus prone to suffer from inadequate pain management.

A prospective observational study consecutively recruited 100 war trauma victims from two tertiary hospitals in the Gaza Strip. During the first four days of hospitalization (Days 0-3), the study evaluated the patients' subjective pain experiences before and after analgesia using the numerical rating scale (NRS), and assessed pain evaluation, documentation, and management practices.

Most participants were young males who underwent surgical interventions on their first day of hospitalization. None of the patients received a formal pain assessment, and nearly two-thirds of patient records lacked documentation of pain. The most frequently prescribed analgesics were diclofenac (33%), paracetamol 1 g (27%), and a combination of paracetamol 1 g with diclofenac 75 mg (18%), while opioid use was severely limited. Additionally, none of the patient records included on-demand analgesia. Pain relief was reported in 85%, 92%, 93%, and 91% following analgesia administration on admission days 0-3, respectively. The decrease in pain scores was significant across the studied days (p < 0.001), with average reductions of 4.26 points on admission day, 4.61 points on Day 1, 4.53 points on Day 2, and 4.27 points on Day 3.

For most patients, the mean pain intensity decreased despite incomplete pain assessments and very limited opioid use. The study highlights the urgent need for context-specific improvements in pain assessment, documentation, and access to essential analgesics in conflict settings.