Manejo del dolor en la isquemia crítica de las extremidades: un estudio transversal multicéntrico

Chronic Limb-Threatening Ischaemia (CLTI) is characterised, in part, by persistent ischaemic rest pain lasting for two weeks or more. Pain management in these patients remains challenging. The World Health Organisation (WHO) analgesic ladder, developed mainly from research on oncological pain, may lead to suboptimal pain relief and significant side effects in vascular patients.

To evaluate effective pain management in hospitalised patients with CLTI using the Brief Pain Inventory (BPI) score.

A cross-sectional study was conducted across two teaching hospitals on vascular patients with a primary diagnosis of CLTI. Data collected included BPI, which measures a patient's pain severity and its impact on daily function across seven 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 revascularisation or amputation.

One hundred and four patients (median age 69 years [IQR 60-76]; 64.4% male) were included. Median current pain was 5/10 (IQR 3-7.5), and 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 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 ischaemic pain. Further research is urgently needed to establish evidence-based analgesic strategies specific to ischaemic pain.