Pain management in chronic limb-threatening ischaemia: a multi-centre cross-sectional study.

Abstract

Chronic limb-threatening ischaemia (CLTI), the most advanced form of peripheral arterial disease, is associated with severe ischaemic pain that profoundly affects quality of life. Despite this, pain management in CLTI has received limited research attention, particularly in China. We carried out a multi-centre cross-sectional study to assess pain severity, functional impact, and analgesic prescribing among hospitalised CLTI patients in Zhejiang Province. Between January 2024 and December 2024, we recruited 236 consecutive inpatients with CLTI from six hospitals: one tertiary centre and five county-level hospitals. Eligible patients were aged >=18 years, had a primary diagnosis of CLTI (Fontaine stage III-IV or Rutherford 4-6), were experiencing pain, and could provide a reliable self-assessment. Pain was evaluated using the Brief Pain Inventory. Prescribing data were extracted from electronic medical records. The primary outcome was the proportion with moderate-to-severe pain (NRS >=5/10). The median age was 72 years and 66.1% were male. A large majority (88.6%) reported moderate-to-severe pain. Median scores were: current pain 6/10, worst pain 8/10, average pain 6/10. Pain interfered most with walking ability (median 8/10), sleep (7/10), and general activity (7/10). Analgesic use was limited: paracetamol 74.2%, weak opioids 34.7%, morphine 30.5%, oxycodone 22.5%. Eight patients (3.4%) received no analgesic therapy. Among those with severe pain (>=7/10), 18.8% were not prescribed any strong opioid. Overall, 54.7% reported inadequate analgesia (<=50% pain relief). Significant urban-rural disparities were observed in strong opioid prescribing. Pain management among hospitalised CLTI patients in this Chinese cohort is frequently suboptimal. The high prevalence of uncontrolled pain, low utilisation of strong opioids, and marked functional impairment point to an opportunity for quality improvement for improved practice. Given the single-time-point nature of this assessment, these findings highlight a critical gap in initial symptom control. Development of China-specific clinical guidelines, wider adoption of nursing-led pain assessment, and better access to analgesics in county hospitals should be prioritised. Future clinical trials of multimodal strategies for ischaemic pain are also warranted.