Severity and factors associated with pain in patients on mechanical ventilators in Amhara region, North-West Ethiopia: a multi-center prospective observational study.

Pain in patients in the intensive care unit (ICU) who are on mechanical ventilators has a range of consequences that impact both their physical and mental recovery. Therefore, this study aims to assess the severity of pain at rest and the factors associated with it among patients on mechanical ventilators in the intensive care units. A multi-center prospective observational study was conducted among patients on mechanical ventilators in the intensive care unit of comprehensive specialized hospitals in the Amhara Region of North-West Ethiopia, from October 10, 2024, to January 15, 2025. Data were collected using a semi-structured questionnaire. Pain status was assessed every four hours on the first day of ICU admission using the Behavioral Pain Scale (BPS). Consecutive sampling was employed to select participants. Data were entered into EPI-data version 4.6 and transferred to Stata version 17 for analysis. Both bivariable and multivariable logistic regression analyses were performed to identify factors associated with pain. This study was conducted among 234 patients. We found the severity of pain as follows: 60 patients (25.64%) experienced no pain, 118 patients (50.43%) experienced mild pain, and 56 patients (23.93%) experienced unacceptable (significant) pain. Additionally, in this study, being female (AOR = 2.45, 95% CI 1.42-4.22), surgical cause of admission (AOR = 2.27, 95% CI 1.31-3.93)), anxiety (AOR = 3.78, 95% CI 2.03-7.04), and Combination of analgesia (opioid and non-opioid) (AOR = 0.37, 95% CI 0.21-0.65) had a significant association with pain. This study revealed that a significant proportion of patients (23.93%) experienced unacceptable levels of pain. Factors significantly associated with increased pain severity included being female, having a surgical cause for admission, and experiencing anxiety. Conversely, the use of a combination of opioid and non-opioid analgesics was significantly linked to reduced pain severity. These findings underscore the importance of recognizing demographic, clinical, and psychological factors in pain assessment. Based on the findings, it is recommended to prioritize routine pain assessments, especially for female and surgical patients. Additionally, anxiety screening and management should be integrated into patient care, and the use of combined opioid and non-opioid analgesics should be encouraged to effectively reduce pain severity.