One in seven hospital patients in Africa suffers severe pain, UCT study finds - TimesLIVE

A hospital stay is meant to bring relief, but for thousands of patients across Africa, it can also mean enduring severe pain. A study has found one in seven hospital patients experienced severe pain, while two-thirds reported some level of pain.

The study, led by researchers at the University of Cape Town (UCT), has found 67.9% of adults admitted to hospitals across Africa experienced some level of pain, while 14.4% reported severe pain, defined as a score of seven or more out of 10.

Researchers studied 19,438 patients in 180 hospitals across 22 African countries between September and December 2023. The patients were followed up for seven days to determine whether they survived or died in hospital.

The findings, published in the journal PAIN, provide what the researchers describe as the first large-scale evidence of the burden of acute pain among hospitalised patients across Africa.

The study found about one-third of patients reported no pain, while 28% reported mild pain, 25.4% moderate pain and 14.4% severe pain.

Pain was particularly common among patients who had been admitted after trauma.

More than eight in 10 trauma patients (84.1%) experienced pain, while 20.3% reported severe pain. This was higher than among patients admitted with non-communicable diseases, where 62.6% experienced pain and 12.5% reported severe pain.

Patients in surgical wards also reported more pain than those in medical wards. In surgical wards, 16.2% reported severe pain compared with 11.1% in medical wards.

High-care units recorded one of the highest levels of severe pain, at 19.3%, compared with 14% in general wards.

The researchers found no meaningful overall difference in pain severity between men and women.

The median pain score among all patients was three out of 10. The researchers also found no evidence that pain severity was associated with whether a patient was classified as critically ill.

However, a different pattern emerged when researchers looked at deaths.

After taking other factors into account, increasing pain severity was associated with increased odds of dying in hospital within seven days. The study found patients with severe pain were more likely to die within seven days than those without severe pain.

However, researchers stressed the finding should not be interpreted to mean severe pain causes death because the study was observational and cannot establish cause and effect. Severe pain could instead be a sign of an underlying illness or injury that makes a patient more vulnerable to poor outcomes.

The study did not record which pain medicines or other treatments patients received. This means the researchers could not determine whether specific pain relief approaches reduced pain or affected patients’ survival chances.

Dr Gillian Bedwell, a postdoctoral fellow in UCT’s African Pain Research Initiative who led the study, said further research was needed to understand the relationship between pain and poor outcomes.

“Further studies are needed to determine whether pain is a warning sign, a contributor to poor clinical outcomes, or both,” she said.

The findings also highlight how little is known about pain among hospital patients in Africa.

“Africa has historically had little large-scale data on pain among hospitalised patients. Previous international estimates have largely come from high-income countries, leaving a major gap in understanding what patients experience in African hospitals,” said Bedwell.

The researchers found the burden of pain was similar to levels reported in high-income countries, despite major differences in health care resources.

Bedwell said pain should not simply be seen as something patients have to endure while doctors treat the illness or injury that brought them to hospital.

“Acute pain in hospital is sometimes viewed primarily as a symptom to be endured while the underlying illness or injury is treated. But poorly managed acute pain can have broader consequences for patients, their families and health systems.”

For patients, those consequences can extend beyond the immediate discomfort.

The researchers said poorly managed acute pain can affect sleep, movement and rehabilitation and has been linked to delayed recovery and other clinical complications.

Its effects can also continue after a patient leaves hospital, potentially delaying their return to normal activities and work and increasing the demands placed on caregivers and health care services.

“Recognising and managing pain effectively should be a fundamental part of providing high-quality hospital care,” said Bedwell.

The researchers said the next step is to establish how pain is assessed and managed in African hospitals and to understand what prevents patients from receiving effective pain relief.

They also want to identify strategies that could improve pain management in Africa’s hospitals.

The study involved patients from 22 countries and territories including South Africa, Botswana, Lesotho, Namibia, Nigeria, Ghana, Kenya, Tanzania, Uganda, Zimbabwe, Mozambique and Morocco.

The research formed part of the African Critical Illness Outcomes Study and was supported by the National Institute for Health and Care Research Global Health Group in Perioperative and Critical Care.