Email this article Management of pain in outpatients with critical limb ischemia
Abstract
Introduction: Critical limb ischemia (CLI) is a condition resulting from chronic impaired limb perfusion by arterial blood, which is always accompanied by rest pain. The key objectives of treatment are to prevent high-level amputations and to manage pain. Currently there are no strong recommendations regarding pharmacotherapy for pain in patients with CLI.
The aim of the study was to evaluate analgesics currently used in patients with CLI on an outpatient basis and to assess their effectiveness in pain treatment.
Materials and methods: The study included 88 patients diagnosed with CLI, who declared taking a painkiller in the past 12 h. Patients were asked for the name of the drug. The truth of the declaration was verified by the presence of the drug in the serum of 45 randomly selected patients. All patients rated pain intensity on a numerical scale (NRS) before and after treatment. Their mental state was evaluated by Mini-Mental State Examination (MMSE) test.
Results: The most commonly used analgesics were ketoprofen, ibuprofen and acetaminophen. Pain management was successful in 11.4% of patients. Average pain intensity before taking the
drug was 8.34 points (SD 1.27) and 5.85 (SD 1.57) after. In only 11 patients the presence of the declared drug was confirmed in serum. In 22 patients other drugs were found. For patients who reported that analgesic medication was ineffective, MMSE value averaged 22.1 (SD 4.95) and 25.1 (SD 4.25) for the group reporting effective treatment, p = 0.07. Patients reporting ineffectiveness of medications had suffered for an average duration of 8.2 weeks (SD 1.39), while the effective group average 5.2 weeks (SD 5.13), p = 0.06.
Conclusions: Treatment of pain in patients with CLI in an outpatient setting is ineffective because it is based on medications used in the treatment of nociceptive pain and not neuropathic pain. There is an urgent need to improve the treatment of pain in patients with CLI by educating family doctors.
The aim of the study was to evaluate analgesics currently used in patients with CLI on an outpatient basis and to assess their effectiveness in pain treatment.
Materials and methods: The study included 88 patients diagnosed with CLI, who declared taking a painkiller in the past 12 h. Patients were asked for the name of the drug. The truth of the declaration was verified by the presence of the drug in the serum of 45 randomly selected patients. All patients rated pain intensity on a numerical scale (NRS) before and after treatment. Their mental state was evaluated by Mini-Mental State Examination (MMSE) test.
Results: The most commonly used analgesics were ketoprofen, ibuprofen and acetaminophen. Pain management was successful in 11.4% of patients. Average pain intensity before taking the
drug was 8.34 points (SD 1.27) and 5.85 (SD 1.57) after. In only 11 patients the presence of the declared drug was confirmed in serum. In 22 patients other drugs were found. For patients who reported that analgesic medication was ineffective, MMSE value averaged 22.1 (SD 4.95) and 25.1 (SD 4.25) for the group reporting effective treatment, p = 0.07. Patients reporting ineffectiveness of medications had suffered for an average duration of 8.2 weeks (SD 1.39), while the effective group average 5.2 weeks (SD 5.13), p = 0.06.
Conclusions: Treatment of pain in patients with CLI in an outpatient setting is ineffective because it is based on medications used in the treatment of nociceptive pain and not neuropathic pain. There is an urgent need to improve the treatment of pain in patients with CLI by educating family doctors.
Keywords
critical limb ischemia; pharmacotherapy of pain
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PDFDOI: https://doi.org/10.21164/pomjlifesci.605
Copyright (c) 2019 Paweł Rynio, Miłosław Cnotliwy, Arkadiusz Kazimierczak, Anna Rakocz, Teresa Dembińska, Monika Tyszkiewicz-Bandur, Piotr Gutowski
License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/