Results
neuropathic, chronic pain, pains, pain
EVENTS, CHRONIC PAIN
The study is based on our own clinical experience of treating 769 patients with gunshot wounds during hostilities. All patients were divided into two groups: Group 1 – patients with gunshot wounds with 1.2 localizations of injured anatomical parts of the body; Group 2 – patients with gunshot wounds with the number of localizations of injured anatomical parts of the body > 2. Thus, 630 patients were assigned to Group 1, and 139 patients to Group 2.The results of the treatment were evaluated according to VAS – if after 3 months the patient feels pain, then such pain is considered chronic.The distribution law is different from normal, the median Me and the interquartile range (QI-QIII) are presented. General characteristics of patients (see Table General characteristics of patients (median Me and interquartile range are presented) (QComparisons were made using the Mann–Whitney testDuring the analysis, no statistically significant difference in the age of patients in the groups was found (Frequency of cases (abs. (%)) of patients with gunshot woundsComparisons were made using the chi-square test, adjusted for continuityDuring the analysis, no statistically significant difference of patients was found in the groups according to the assessment of the condition of the patients before the surgical intervention according to the classification of the American Society of Anesthesiologists (ASA) – Intensity of pain according to VAS at admission to the stages of treatment and after analgesia (see Table Data on pain intensity during VAS and after analgesia at admission to different stages of treatment in patients with gunshot wounds7(7–8)8(7–9)7(6–7)7(6–7)6(4–7)6(5.25–7)2(2–2)2(2–2)4(4–4)4(4–4)4(4–4)4(4–4)2(2–3)3(2–3.75)Comparisons were made using the Mann–Whitney test. * – difference is significant by the FDR method (Benjamini, Y. and Hochberg, Y., 1995)Based on the obtained data, the following conclusion can be drawn: in the medical and nursing teams before anesthesia (on admission), the intensity of pain according to VAS in Groups 1 and 2 met the criteria of severe pain (ranged from 7 to 9 points), and a difference was observed depending on localization – in patients from Group 2, the intensity of pain according to VAS is higher than in patients from Group 1 (Patients with gunshot wounds, depending on the localization of the wound, at different stages of treatment, need to pay more attention to the tactics of pain treatment, because the lack of quality pain control and insufficient analgesia can have a significant impact on the long-term results of pain treatment, namely on its chronicity.Dynamics of pain intensity according to VAS at different stages of treatment (see Fig. Dynamics of pain intensity according to VAS at different stages of treatment in patients with gunshot wounds: 1, 2 – stage of treatment: medical and nursing teams; 3, 4, 5, 6, 7 – stage of treatment: military mobile hospitals; 8, 9, 10, 11, 12, 13, 14, 15 – stage of treatment: military medical clinical centers; 16, 17, 18, 19 – stage of treatment: rehabilitation. Notes: Comparisons were made using the Mann–Whitney test. * – difference is significant by the FDR method (Benjamini, Y. and Hochberg, Y., 1995)From the results of the analysis, it is clear that in Groups 1 and 2 from the 1st to the 8th day of observation, the intensity of pain according to the VAS practically did not differ and ranged from 3 to 7 points, which corresponds to the criteria of moderate and severe pain: from 1 From the 7th to the 7th day of observation, the pain intensity was moderate, but on the 8th day, the pain had the highest intensity and was characterized as severe pain (see Fig. Dynamics of the VAS indicator for patients with gunshot wounds of two groups at different stages of treatment: 1 – 1 day of observation, 2 – 3 days of observation, 3 – 5 days of observation, 4 – 8 days of observation, 5 – 10 days of observation, 6 – 14 days of observation, 7 – during discharge from the military medical clinical center, 8 – 1 month after the injury, 9 – 3 months after the injury, 10 – 6 months after the injury, 11 – 12 months after the injury. The average value of the indicator and its 95% CI are indicatedThat is, in patients who received gunshot wounds with the localization of 3 or more anatomical sites, the intensity of pain according to the VAS starting from the 9th day of observation is higher than in patients who received gunshot wounds with the localization of 1 or 2 anatomical sites (see Fig. Analyzing the dynamics of pain intensity according to VAS in 2 groups, it can be concluded that the number of localizations of injured anatomical areas is important in predicting the tactics of pain treatment in patients with gunshot wounds.Dynamics of intervals between analgesia at different stages of treatment (see Table From the results of the analysis, it is clear that in the 2 Groups during the 1st day of observation, upon admission at the stage of treatment in medical and nursing teams, the intervals between analgesia statistically differed (Dynamics of intervals between analgesia for patients with gunshot wounds of two groups at different stages of treatment: 1 – 1 day of observation, 2 – 3 days of observation, 3 – 5 days of observation, 4 – 7 days of observation, 5 – 9 days of observation, 6 – 11 days observation, 7–13 days of observation. The average value of the indicator and its 95% CI are indicatedIntervals between analgesia in patients with gunshot wounds at different stages of treatment6(6–6)6(6–6)6(6–6)6(6–6)6(6–6)6(6–6)6(6–6)6(6–6)6(6–6)6(6–7)6(6–7)6(6–7)6(6–7)6(6–7)6(6–7)6(6–7)7(6–7)6(6–7)8(7–8)7(6–8)8(8–9)9(9–9)10(9–12)9(9–12)11(10–12)11(11–12)12(11–12)11(11–12)Comparisons were made using the Mann–Whitney test. * – difference is significant by the FDR method (Benjamini, Y. and Hochberg, Y., 1995)Diagnosis of the neuropathic component of pain in patients with gunshot wounds (see Table The results of the diagnosis of the neuropathic component of pain in patients with gunshot wounds depending on the number of injury localizations of anatomical parts of the body at different stages of treatment during the observation period5(4–5)5(4–5)5(5–5)5(5–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)5(2–5)Comparisons were made using the Mann–Whitney testThe Mann–Whitney test was used to compare two groups. From the results of the analysis, it is clear that there is no statistically significant difference at all stages of treatment, in particular when comparing at the stage of military mobile hospitals – Dynamics of the DN4 indicator for patients of two groups: 1 – during treatment in military mobile hospitals, 2 – during treatment in military medical clinical centers, 3 – during discharge from military medical clinical centers, 4 – 1 month after injury, 5 – 3 months after injury, 6 – 6 months after injury, 7 – 12 months after injury. The average value of the indicator and its 95% CI are indicatedAssessment of the level of satisfaction with treatment results (see Table Satisfaction with treatment outcomes in patients with gunshot wounds during follow-up73(68–76)73(68–76)64(64–68)64(64–68)64(64–68)64(64–68)64(64–68)64(64–68)64(64–68)64(64–68)Comparisons were made using the Mann–Whitney testThe Mann–Whitney test was used to compare two groups. Table Analyzing the dynamics of the assessment of the level of satisfaction with the results of treatment in patients with gunshot wounds, it is clear that the maximum level of satisfaction with the results of treatment in patients of the two groups during the entire observation period was before discharge from inpatient treatment and ranged from 68 – the average level of satisfaction to 76 points – this corresponds to high level of satisfaction. Later, after 1, 3, 6 and 12 months of observation, this indicator decreased and ranged from 64 to 68 pains, which corresponds to the average level of satisfaction with the treatment results. Taking into account that the level of satisfaction with the results of treatment depends partly on the patient's psychological status, unpleasant sensations in the anatomical area of the injury and emotional experiences that are associated with the events and circumstances in which the patient was injured, such results indicate the probability of the influence of chronic pain on level of satisfaction with treatment results.