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Journal Articles Critical Care Year : 2023

Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study

1 Nantes Univ - Nantes Université
2 Hôtel-Dieu de Nantes
3 Hôpital Maison Blanche
4 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
5 PI3 - Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression
6 Hôpital Edouard Herriot [CHU - HCL]
7 BIOMERIEUX
8 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
9 Hôpital d'instruction des Armées Percy
10 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
11 PHAR2 - Pharmacologie des anti-infectieux et antibiorésistance
12 Université de Poitiers - Faculté de Médecine et de Pharmacie
13 Centre hospitalier de Saint-Nazaire
14 GHBS - Groupe Hospitalier Bretagne Sud
15 Hôpital Claude Huriez [Lille]
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
17 OSS - Oncogenesis, Stress, Signaling
18 CHU Rouen
19 CHU Trousseau [Tours]
20 CHU - BREST - DAR - CHRU Brest - Département d'Anesthésie Réanimation
21 IGR - Institut Gustave Roussy
22 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
23 CH Aubagne
24 Hôpital de Hautepierre [Strasbourg]
25 CHBA Vannes
26 Hôpital d'Instruction des Armées Clermont Tonnerre
27 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
28 CH Cholet - Centre Hospitalier de Cholet
29 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
30 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
31 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
Samia Boubeche
  • Function : Author
Julie Darrieussecq
  • Function : Author
Agathe Delbove
  • Function : Author

Abstract

Background Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. Methods We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. Results Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4–12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1–5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1–2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3–4]), prone positioning (OR 3 95% CI [1.4–6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7–3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1–6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. Conclusions Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. Trial registration. NCT04817696. Registered March 26, 2021.
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hal-04141716 , version 1 (31-10-2023)

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Alexandre Bourdiol, Vincent Legros, Fanny Vardon-Bounes, Thomas Rimmele, Paul Abraham, et al.. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study. Critical Care, 2023, 27 (1), pp.199. ⟨10.1186/s13054-023-04491-w⟩. ⟨hal-04141716⟩
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