Pain Management in Chronic Limb-Threatening Ischemia: A Multicentre Cross-Sectional Study

Chronic limb-threatening ischemia (CLTI) is characterized, in part, by persistent ischemic rest pain lasting for 2 weeks or more. Pain management in these patients remains challenging. The World Health Organization analgesic ladder, developed mainly from research on oncological pain, may lead to suboptimal pain relief and significant side effects in vascular patients. The objective of the study was to evaluate effective pain management in hospitalized patients with CLTI using the Brief Pain Inventory score.

A cross-sectional study was conducted across 2 teaching hospitals on vascular patients with a primary diagnosis of CLTI. Data collected included Brief Pain Inventory, which measures a patient's pain severity and its impact on daily function across 7 domains. Further data were also collected on analgesia regimens and their subsequent impact on overall pain scores, as well as whether the patient had undergone a recent or planned revascularization or amputation.

One hundred four patients (median age 69 years [interquartile range (IQR) 60-76]; 64.4% male) were included. The median current pain was 5/10 (IQR 3-7.5), and the worst pain in the previous 24 hours was 8/10 (IQR 5-10). Moderate to severe pain (≥5/10) was reported by 80.7% of patients. Despite the widespread use of paracetamol (93.7%) and strong opioids (morphine 50%; oxycodone 38.9%), 39.6% reported inadequate pain relief. Pain interfered with general activity (76.7%), mood (67.0%), mobility (83.5%), and sleep (73.6%) in the majority of patients. Among patients with severe pain (≥7/10), 14.2% had no strong opioid documented and 6.3% of the total cohort received no paracetamol.

This study demonstrates that pain management for inpatients with CLTI is inadequate and negatively affects nearly all aspects of life for most patients. This is likely due to a lack of research and understanding of the mechanisms of ischemic pain. Further research is urgently needed to establish evidence-based analgesic strategies specific to ischemic pain.