Pain Assessment in Unconscious Patients in Intensive Care Units: Knowledge, Attitudes, and Practices of Healthcare Providers in Mahajanga (Madagascar)

Introduction: Pain assessment in unconscious patients remains a major challenge in intensive care and critical care settings because of patients’ inability to communicate verbally. Although the use of validated assessment tools is recommended, their implementation remains insufficient, particularly in resource-limited settings. This study aimed to assess the knowledge, attitudes, and practices of healthcare professionals regarding pain assessment in unconscious patients.

Methods: A descriptive cross-sectional study was conducted in November 2025 in two university hospitals in Mahajanga. Physicians and nurses working in intensive care units, emergency departments, and critical care units were included. Data were collected using a structured questionnaire and analyzed using SPSS version 26.

Results: A total of 22 healthcare professionals were included. All participants acknowledged that unconscious patients may experience pain; however, only 27.3% were aware of validated pain assessment tools. A minority (13.6%) reported routinely using a validated assessment scale. The main barriers identified were lack of training (81.8%), absence of appropriate assessment tools (55.6%), and workload overload (38.9%). The use of validated tools was significantly associated with specific training in pain assessment (p = 0.02).

Conclusion: Despite adequate theoretical awareness, pain assessment in unconscious patients remains insufficiently integrated into routine clinical practice. Strengthening healthcare professionals’ training and implementing standardized protocols are essential to improve the quality of care.