Background: The 82.1% treatment failure of post-traumatic stress disorder (PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes. Methods: A total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC – Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment. Results: The predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p = 0.002), OR = 0.30 (95% CI 0.13-0.69) and the regional one with sedation (p = 0.004), OR = 0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p = 0.02), OR = 3.2 (95% CI 1.2-8.3). Conclusions: The analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes. Trial registration: ClinicalTrials.gov: Retrospectively registered on December 30, 2020, NCT04689022.

In civilian life, from 11 to 40% of patients suffer from chronic pain after receiving injuries. There are almost no data on chronic pain in patients with gunshot wounds, isolated clinical cases have been published. The purpose of our study is to determine the factors that can potentially affect the results of treatment of such patients, namely the frequency of development of chronic pain, acute stress reactions, satisfaction with the results of treatment and the number of wound localizations. The treatment of 769 patients was analyzed. Pain intensity was diagnosed using a visual analog scale (VAS). To detect neuropathic pain, the Douleur Neuropathique 4 questions (DN4). The presence of an acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist. Satisfaction with treatment results was studied using the Chaban quality of life scale (CQLS). Group comparisons were made using the Mann–Whitney test and the chi-square test, taking into account continuity correction. Chronic pain was observed in 538 (70% 95% CI 66.7%-73.1%) patients with gunshot wounds: of them, 439 patients had wounds in 1, 2 anatomical parts of the body, here the frequency of pain chronicity is 69.7% (95% CI 66.0%-78.5%), and 99 patients had wounds in 3 or more anatomical parts of the body – 71.2% (95%CI 63.4%-78.5%). DN4 data suggest the presence of a neuropathic pain component in these patients. Also, all patients were diagnosed with ASR upon admission: the number of HADS points ranged from 9 to 25 points. CQLS data indicate that satisfaction with treatment outcomes was high (76 points) before hospital discharge, but subsequently decreased to a low level (64 points). Patients with gunshot wounds have a high risk of chronic pain, averaging 45% higher than the general population in civilian trauma patients. A greater frequency of the neuropathic component of pain and acute stress reactions is the reason for such chronicity. A decrease in the level of satisfaction with the results of treatment, in the remote period of observation, compared to the level at the time of discharge from the hospital, is probably a consequence of the formation of chronic pain. ClinicalTrials.gov: Retrospectively registered on August 1, 2022, NCT05489029.

Patients with gunshot wounds suffer from chronic pain in 70% of cases, and those with mine-blast wounds – in 83.3% of cases. Civilian patients, after serious injuries, in 11-40% of cases. Unfortunately, there is not enough data to study the causes of such a high frequency of pain chronicity. Therefore, the study of the results of pain treatment at the stage of treatment in military mobile hospitals may be able to reveal the reasons for such a high frequency of chronicity. Methods. The treatment of 280 patients with mine-blast wounds was analyzed. The intensity of pain was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The law of distribution differed from the normal one, the median value (Me) and interquartile range (QI-QIII) were given to present quantitative indicators, and the comparison of indicators in the two groups was performed by the Mann-Whitney test. To analyze the dynamics of indicators, the Friedman criterion for linked samples was used, and the posterior comparison was performed using the Bonferroni correction. For qualitative indicators, the absolute frequency of the trait and the relative frequency (%) are presented, and the chi-square test with the correction for continuity was used to compare the two groups. In all cases, the critical level of significance was set at 0.05. Results. The analysis of pain intensity according to the VAS, before anesthesia, upon admission to military mobile hospitals, showed that patients experienced high-intensity pain reaching 7 points. This indicates a lack of effective pain control both at the initial stage of treatment and during evacuation. After anesthesia, VAS data indicate the presence of moderate pain – 4 points. The intervals between analgesic treatments averaged 6 hours. Although the effectiveness of analgesia according to VAS was low. Conclusions. Patients with mine-blast injuries have a very high risk of chronic pain – 57.5% higher than in injured patients in civilian life. The study results point to ways to improve treatment outcomes for this category of patients. Achieving high-quality pain control at the stage of treatment in military mobile hospitals and maintaining the continuity of treatment during an evacuation can potentially reduce the incidence of pain chronicity.

Background: The 82.1% treatment failure of post-traumatic stress disorder(PTSD), associated with gunshot wounds, is related to high incidence of chronic pain syndrome as well as resistance to the PTSD treatment. Defining treatment failure predictors among the PTSD patients with gunshot extremity wounds and the following therapy would improve treatment outcomes. Methods: A total of 218 patients completed the study. The Mississippi Scale for Combat-Related PTSD (M-PTSD) was used for assessment of the treatment outcome rate. The risk relation between treatment failure and factors was assessed by a univariate or multivariate logistic regression method, with the model accuracy measured by the AUC – Area under the ROC curve. The odds ratio (OR) was considered for the qualitative factor assessment. Results: The predictors of the PTSD treatment failure among the patients with gunshot wounds to the extremities are: 1) anesthesia type: the risk of failure is higher with the general anesthesia compared to the regional (p=0.002), OR=0.30 (95% CI 0.13-0.69) and the regional one with sedation (p=0.004), OR=0.30 (95% CI 0,14-0.65); 2) severe postoperative pain: the risk of treatment failure rises with increased pain intensity assessed by the visual analogue scale (p=0.02), OR=3.2 (95% CI 1.2-8.3). Conclusions: The analysis showed that administration of general anesthesia compared to the regional one (regardless of the sedation) and high postoperative pain intensity are associated with higher risk of the PTSD treatment failure among patients with gunshot wounds to the extremities. The preference of regional anesthesia and postoperative pain control may potentially improve the treatment outcomes. Trial registration ClinicalTrials.gov: Retrospectively registered on December 28, 2020, NCT04689022

The outcome of pain treatment in patients with wounds at different stages of management is important, because chronic pain is diagnosed in 83.3 % of victims with blast injuries, and in 70 % of people with gunshot wounds. In civilian life, chronic pain occurs in 11–40 % of cases in a similar category of patients. The reasons for such a high frequency of chronicity have not been sufficiently studied. Thus, the study on the influence of the number of injured anatomical parts of the body on the results of pain treatment will play an important role and contribute to improving the latter in this category of patients. One of the factors that can influence pain chronicity is the number of injured anatomical parts of the body.