Acute Pain Management: Prevalence and Strategies for Improvement in Nakuru Sub-County, Kenya

Abstract

The effective management of acute pain remains a challenge to many households especially in resource-poor countries. In Kenya, healthcare seeking behavior associated with the management of acute pain at the household level has not been clearly documented. The aim of this study was to establish the prevalence of acute pain and derive strategies for improving its management. A longitudinal study design was utilized. At baseline, data on socio-demographic characteristics, perception of pain and the nature of acute pain were collected. Acute pain was assessed using the universally validated Short-Form McGill Pain Questionnaire. A pre-tested questionnaire was used to collect data from 404 randomly selected households in Nakuru County. The mean age of the respondents at the start of the study was 28.85 years (SD = 10.30), with 53% being males. The prevalence of acute pain at the inception of the study was estimated to be 51% (CI = 46-56). Respondents were resurveyed three and six months later to assess the effectiveness of the treatment options they had adopted to manage acute pain. At three months, 77% of all respondents with acute pain were successfully resurveyed. Six months later, 61% of all respondents with acute pain were contacted. Self-medication was the most prevalent treatment option used as it was practiced by 76% of the respondents during the entire study period. From self-reports, most of the respondents (77%) considered that the treatment option they used as effective. Statistical models that utilize Gibbs sampling and data augmentation were used to establish the factors that explain the use of effective healthcare services following the onset of acute pain. Respondents with superior perception of pain relative to their less endowed peers tended to report effective management of acute pain (t196 = 3.12, ρ < 0.05). Insightfully, sex, age, pain intensity, group diversity and obtaining help from neighbors were found to be statistically significant correlates of perception of pain. Male sex was associated with a 7.50 (CI = 11.74-3.28) decline in perception of pain. Further, the addition of one unit in the duration of pain was associated with a 2.45 (CI = 0.26-4.65) increase in the pain perception. Group diversity on the other hand was inversely associated with the perception of pain (β = 1.85, CI = 2.66-1.12). The likelihood of getting help from close neighbours was negatively associated with pain perception (β = 0.26, CI = 4.29-0.61). Further, results show that the studied sample required to enhance their perception of pain generally by 20.52% (CI = 12.99 - 39.47) in order to be in a position to manage acute pain effectively. The results therefore suggest that the parsimonious formulation adopted in this study, with effective management of acute pain postulated to depend on perception of pain which in turn depends on human capital, social capital and burden of pain is a good approximation of the actual decision-process affecting health care seeking behavior. Need therefore exists to avail iinformation on treatment options, goals, and likely benefits and probability of success. This can be effected by a variety of techniques, including empowering groups and networks, or instead, by broadening the experience of individuals. Pain perception can also be effected by reducing the intensity of pain. Advocacy activities, educational and promotional programs that focus on effective management of acute pain are recommended.