Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector6239310.17816/RA62393Original study articlesОригинальные исследованияResearch ArticleFactors and characteristics of chronic pain in survivors of critical conditionsФакторы риска и особенности хронической боли у пациентов, переживших критическое состояниеhttps://orcid.org/0000-0002-2797-4740SpasovaArina P.СпасоваАрина Павловна
Russian Federation

MD, PhD, Assistant Professor of Chair of X-Ray diagnostic and X-Ray treatment with course of Critical And Respiratory Medicine

к.м.н., доцент кафедры лучевой диагностики и лучевой терапии с курсом критической и респираторной медицины

arina22@mail.ruhttps://orcid.org/0000-0001-6317-1243BaryshevaO. Y.БарышеваО. Ю.
Russian Federation
arina22@mail.ruhttps://orcid.org/0000-0003-1128-9666TikhovaG. P.ТиховаГ. П.
Russian Federation
arina22@mail.ruhttps://orcid.org/0000-0002-5978-1804MaltsevV. V.МальцевВ. В.
Russian Federation
arina22@mail.ruhttps://orcid.org/0000-0002-3400-8989KoriachkinV. A.КорячкинВ. А.
Russian Federation
arina22@mail.ruInstitute of Medicine, Petrozavodsk State UniversityМедицинский институт ФГБОУ «Петрозаводский государственный университет» Министерства науки и высшего образования Российской ФедерацииSaint Petersburg State Pediatric Medical University of MH RFФГБОУ «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской Федерации081220201441932050103202101032021Copyright ©; 2020, Eco-VectorCopyright ©; 2020, ООО "Эко-Вектор"2020Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/62393

This study aimed to determine the factors that affect the development of chronic pain in patients who recovered from a critical illness and to explore characteristics of pain.

Material and methods. This study included a total of 112 patients with surgical pathology who stayed in the intensive care unit (ICU) and subsequently discharged from the hospital. Before discharge, patients were assessed using a short pain questionnaire, the PainDetect questionnaire to assess the neuropathic component of pain, and the HADS questionnaire to verify the presence of anxiety and depression. After 6 and 12 months, catanamnestic data were analyzed, and neuro-orthopedic examination and repeat testing were performed. The duration of ventilation and ICU and hospital stays were assessed as risk factors. The APACHE-II scale score and the maximum SOFA scale score were used as severity parameters of critical conditions. The maximum level of C-reactive protein (CRP) was recorded as a marker of inflammation. The Charlson comorbidity index was used to assess baseline comorbidity.

Results. After 6 months, pain syndrome developed in 55.6% of the patients, and after 12 months, the average pain intensity was 4 points on the verbal rating scale in 59% of the patients. Neuropathic pain was diagnosed in 34% of the patients. The most frequent location of pain was the shoulder joint area, and both shoulders were affected by pain in 58.2% of the patients. In the period from 6 months to 1 year after discharge from the ICU, the risk factors for chronic pain were the duration of ventilator use, ICU stay, and CRP level. Age and gender did not affect the development of chronic pain in patients who recovered from critical illness.

Conclusions. Chronic pain is a complication in more than half of the patients with critical illness. A third of patients with chronic pain experienced neuropathic pain, which requires a comprehensive approach to relieve pain.

Целью исследования было определение факторов, влияющих на формирование хронического болевого синдрома у пациентов, перенёсших критическое состояние, и особенностей характеристик боли.

Материалы и методы. Было включено 112 пациентов с хирургической патологией, находившихся в ОИТ и впоследствии выписанных из стационара. Перед выпиской пациенты были тестированы с помощью краткого опросника боли, опросника PainDetect для оценки нейропатического компонента боли, опросника HADS для верификации тревоги и депрессии. Через 6 и 12 мес проанализированы катанамнестические данные, проведено нейроортопедическое обследование и выполнено повторное тестирование. В качестве факторов риска оценивали продолжительность ИВЛ, пребывания в ОРИТ и стационаре. В качестве параметра тяжести критического состояния использовали шкалу APACHE-II и максимальный балл по шкале SOFA. Как маркер воспаления регистрировали максимальный уровень С-реактивного белка. Индекс коморбидности Чарлсон использовали для оценки исходных сопутствующих заболеваний.

Результаты. Через 6 мес болевой синдром развился у 55,6%, а через 12 мес у 59% пациентов, средняя интенсивность боли составила 4 балла по ШВО. Нейропатический компонент боли диагностирован у 34% пациентов с болевым синдромом. Самой частой локализацией боли была область плечевого сустава, у 58,2% пациентов болью были поражены оба плеча. Факторами риска хронической боли в период от 6 мес до 1 года после выписки из ОРИТ были длительность пребывания на ИВЛ и в ОРИТ, уровень СРБ. Возраст и пол не влияли на формирование хронической боли после перенесённого критического состояния.

Выводы. Хроническая боль является проблемой для более половины пациентов, перенёсших критическое состояние. У трети пациентов с хронической болью имеется нейропатический компонент болевого синдрома, что требует комплексного подхода к её облегчению.

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