Chronic pain in ICU survivors
Table I. Patient demographics for the physiotherapy intervention group
Patient characteristics Total number of participants
(n = 47) New chronic pain
(n = 31) No new chronic pain
(n = 16)
Sex, male, %
Age, years, median (IQR)
Intensive care unit length of stay, days, median (IQR)
Acute Physiology and Chronic Health Evaluation, median (IQR) 68
52 (43–57)
15 (10–27)
23 (18–27) 55
51 (44–56)
12 (7–27)
23 (18–27) 81
54 (43–59)
19 (11–29)
23 (16–28)
Scottish Index of Multiple Deprivation decile, median (IQR) b 64 58 75
2 (1–4) 3 (1–4) 1 (1–4)
Sepsis, yes, % a
a
Sepsis as defined by the Surviving Sepsis Campaign (2013) (24). b Scottish Index of Multiple Deprivation scores for 1–5, with 1 being the most deprived.
IQR: interquartile range.
Table II. Admitting speciality
Admitting speciality n
General medicine
General surgery
Gastroenterology
Burns and plastics
Orthopaedics
Respiratory medicine
Urology 19
12
5
4
4
2
1
Incidence and location of pain
At baseline assessment, two-thirds (66%, n = 31) of
patients reported a “new” chronic pain since ICU
admission at initial assessment (Table I). In these
patients, lower limb pain was reported in over two-
fifths of this group (42%, n = 13), but the shoulder joint
was the most frequently affected joint (39%, n = 12),
followed by the trunk/back (32%, n = 10), upper limb
(6%, n = 2) and head (3%, n = 1) (Fig. 1). Thirty-nine
percent of patients (n = 12) reporting a “new” chronic
pain, had pain at more than one anatomical location/
joint. Bilateral symptoms were reported in almost all
of those who reported having lower limb pain (85%,
n = 11), in contrast to only one-third of those with
shoulder pain (33%, n = 4).
Brief Pain Inventory intensity/severity
The mean BPI score for pain severity of those reporting
a “new” chronic pain at initial assessment was 5.3
45
Frequency (%)
40
35
30
25
20
15
(standard deviation (SD) 2.4; range 0–10) and the
mean score at 1 year was 4.6 (SD 2.7). The difference
between reported pain severity at baseline and at 1-year
was not significant (p = 0.66).
Brief Pain Inventory interference
The mean BPI score given by patients to describe the
impact of pain on daily function or interference in
those reporting chronic pain was 6.5 (SD 2.5). Pain
interference decreased significantly between baseline
assessment and follow-up at 1-year (mean 6.5 (SD
2.5) vs mean 4.5 (SD 2.7), respectively) (p = 0.04).
Further investigation of pain interference on individual
activities of daily living indicated that “enjoyment of
life” (mean 7.1, SD 2.8) and sleep (mean 6.9, SD 3.3)
were the most severely affected and “relations” the
least affected by chronic pain (mean 5.7, SD 3.5) at
baseline assessment. However, at 1 year “enjoyment
of life” (mean 5.2, SD 3.2) and “normal work” (mean
5.2, SD 3.3) were the most affected.
Predictors
There was no significant difference in any of the vari-
ables, including ICU length of stay (LOS) , age, SIMD
or sepsis, between those with and without chronic pain
(Table III).
Analgesics
The number of patients taking analgesics (steps 1–3
pain medications, as defined by the WHO pain ladder)
prior to admission was 43% (n = 20). This figure had
increased to 81% (n = 38) at the time of the patients’
baseline clinic visit. The intensity of analgesics pres-
cribed also increased, with the number of patients
prescribed strong opioids (step 3 of the WHO pain
Table III. Risk factors for the incidence of chronic pain: results
of binary logistic regression analysis
10
453
5 Variable p-value
0 Intensive care unit length of stay
Age
Scottish Index of Multiple Deprivation
Sepsis 0.53
0.55
0.29
0.09
Lower limbs
Shoulder
joint
Trunk/Back
Upper limb
Head
Fig. 1. Anatomical location of “new” chronic pain at baseline assessment.
J Rehabil Med 51, 2019