1
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Brockway K, Ahmed S. Beyond breathing: Systematic review of global chronic obstructive pulmonary disease guidelines for pain management. Respir Med 2024; 224:107553. [PMID: 38350512 DOI: 10.1016/j.rmed.2024.107553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Patients with chronic obstructive pulmonary disease (COPD) experience pain as both symptom and comorbidity. There has been no evaluation of the recommendations for pain management in updated clinical practice guidelines (CPGs). OBJECTIVES Update the evidence on pain management, determine alignment of pain management recommendations with best-practice, and advocate for optimal pain management in patients with COPD. METHODS PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, Institute of Medicine, grey literature, national websites, and bibliographies were searched. CPGs available online for stable COPD produced by organizations representing reputable knowledge of COPD management were included. CPGs unavailable online, not translatable into English, or not including techniques within the defined scope were excluded. Researchers performed frequency counts for the verbatim terms "pain," "physical activity," "exercise," "rehabilitation," "physical therap(ist)/(y), "physiotherap(ist)/(y)," recorded context, and collected recommendations for pain management/treatment when present. RESULTS Of 32 CPGs, 24 included "pain" verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs referred to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing. CONCLUSIONS Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden is necessary. Pain management should include referrals to providers who can maximize benefit of their services.
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Affiliation(s)
- Kaelee Brockway
- University of St. Augustine for Health Sciences, 901 W. Walnut Hill Ln, Ste 210, Irving, TX, USA.
| | - Shakeel Ahmed
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
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2
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Xiang X, Han M, Luo X, Yu Y, Lu X, Cai S, Huang L. Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial. Sci Rep 2023; 13:22929. [PMID: 38129630 PMCID: PMC10739839 DOI: 10.1038/s41598-023-50099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to evaluate whether a theory-based behavior change intervention could promote changes in physical activity (PA) and sedentary behavior (SB) among patients with chronic obstructive pulmonary disease (COPD), as well as its effects on symptoms of dyspnea, lung function, exercise capacity, self-efficacy, and health-related quality of life (HRQoL). A quasi-experimental design and convenience sampling were adopted. A total of 92 patients with stable COPD were recruited from outpatient and inpatient centers of two hospitals in Zhejiang Province, China. Both the experimental and control groups received standard medical care provided in the hospital. The experimental group performed a PA program based on the behavior change wheel theory. Outcomes were measured at baseline (T0) and after 4 weeks (T1), 8 weeks (T2), and 12 weeks of the intervention (T3). The primary outcome was PA measured by the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included SB measured by the IPAQ, dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, exercise capacity assessed by 6-min walk distance (6MWD), self-efficacy measured by the Exercise Self-Regulatory Efficacy Scale (EX-SRES), and HRQoL measured by the COPD Assessment Test (CAT). In addition, we measured lung function using a spirometer at baseline and 12 weeks. Of the 89 patients included in this study, 64 were male (71.91%), with a mean age of 67.03 ± 6.15 years. At 12 weeks, the improvements in PA, SB, mMRC, 6MWD, EX-SRES and CAT were all statistically significant (P < 0.05) in the experimental group compared to the control group. Repeated measures analysis of variance showed that there were group effects and time effects on total PA, SB, mMRC, 6MWD, EX-SRES, and CAT in both groups (P < 0.001). However, there was no significant difference in pulmonary function between the two groups before and after intervention (P < 0.05). The PA program based on theory significantly increased PA levels, reduced sedentary time, enhanced exercise capacity and self-efficacy as well as HRQoL in patients with stable COPD. Due to the limited intervention time in this study, the pulmonary function of COPD patients may not be reversed in a short time, and the long-term effect of this program on the pulmonary function of patients needs to be further explored.Trial registration: Clinical Trials.gov (ChiCTR2200060590). Registered 05/06/2022.
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Affiliation(s)
- Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Maomao Han
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xiaolin Luo
- Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, Zhejiang Province, China
| | - Yudi Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaorong Lu
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Shasha Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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3
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Morris JR, Harrison SL, Robinson J, Martin D, Avery L. Non-pharmacological and non-invasive interventions for chronic pain in people with chronic obstructive pulmonary disease: A systematic review without meta-analysis. Respir Med 2023; 211:107191. [PMID: 36889522 DOI: 10.1016/j.rmed.2023.107191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Chronic Obstructive Pulmonary Disease (COPD) is complicated by chronic pain. People with COPD report higher pain prevalence than the general population. Despite this, chronic pain management is not reflected in current COPD clinical guidelines and pharmacological treatments are often ineffective. We conducted a systematic review that aimed to establish the efficacy of existing non-pharmacological and non-invasive interventions on pain and identify behaviour change techniques (BCTs) associated with effective pain management. METHODS A systematic review was conducted with reference to Preferred Reporting Items for Systematic Review (PRISMA) [1], Systematic review without Meta analysis (SWIM) standards [2] and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines [3]. We searched 14 electronic databases for controlled trials of non-pharmacological and non-invasive interventions where the outcome measure assessed pain or contained a pain subscale. RESULTS Twenty-nine studies were identified involving 3,228 participants. Seven interventions reported a minimally important clinical difference in pain outcomes, although only two of these reached statistical significance (p < 0.05). A third study reported statistically significant outcomes, but this was not clinically significant (p = 0.0273). Issues with intervention reporting prevented identification of active intervention ingredients (i.e., BCTs). CONCLUSIONS Pain appears to be a meaningful issue for many individuals with COPD. However, intervention heterogeneity and issues with methodological quality limit certainty about the effectiveness of currently available non-pharmacological interventions. An improvement in reporting is required to enable identification of active intervention ingredients associated with effective pain management.
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Affiliation(s)
- Jeanette R Morris
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK.
| | - Samantha L Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK.
| | - Jonathan Robinson
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK.
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK.
| | - Leah Avery
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK.
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4
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Calvache-Mateo A, López-López L, Martín-Núñez J, Heredia-Ciuró A, Granados-Santiago M, Ortiz-Rubio A, Valenza MC. Pain and Clinical Presentation: A Cross-Sectional Study of Patients with New-Onset Chronic Pain in Long-COVID-19 Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054049. [PMID: 36901059 PMCID: PMC10001485 DOI: 10.3390/ijerph20054049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 06/01/2023]
Abstract
The aim of this study was to evaluate the characteristics of pain (i.e., pain intensity, pain interference, clinical presentation) in Long-COVID-19 patients and compare the location of pain between successfully recovered COVID-19 patients and healthy matched controls. A cross-sectional case-control study was carried out. Long-COVID-19 patients, age- and sex-matched patients with a history of COVID-19 who had successfully recovered, and healthy controls were included. Outcomes included were pain characteristics (Brief Pain Inventory and Short-Form McGill Pain Questionnaire) and clinical presentation (Widespread Pain Index and Euroqol-5 Dimensions 5 Levels Visual Analogue Scale). Sixty-nine patients with Long-COVID-19 syndrome, sixty-six successfully recovered COVID-19 patients, and sixty-seven healthy controls were evaluated. Patients with Long-COVID-19 syndrome showed greater pain intensity and interference. In addition, they showed worse quality of life and greater widespread pain, with the most frequent locations of pain being the neck, legs, and head. In conclusion, patients with Long-COVID-19 syndrome show a high prevalence of pain, characterized by widespread pain of moderate intensity and interference, with the most frequent locations being the neck, legs, and head, significantly affecting the quality of life of these patients.
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Affiliation(s)
- Andrés Calvache-Mateo
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Laura López-López
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Javier Martín-Núñez
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Alejandro Heredia-Ciuró
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Araceli Ortiz-Rubio
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Physiotherapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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5
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Kalu ME, Dal Bello-Haas V, Griffin M, Boamah SA, Harris J, Zaide M, Rayner D, Khattab N, Bhatt V, Goodin C, Song JW(B, Smal J, Budd N. Physical mobility determinants among older adults: a scoping review of self-reported and performance-based measures. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2153303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael E. Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila A. Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Vidhi Bhatt
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | | | - Justin Smal
- Manitoulin Physio Centre, M'Chigeeng, Canada
| | - Natalie Budd
- The Arthtitis and Sports Medicine Centre, Ancaster, Canada
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6
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Bamonti PM, Robinson SA, Wan ES, Moy ML. Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:1269-1283. [PMID: 35677347 PMCID: PMC9167842 DOI: 10.2147/copd.s339323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
The Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States (US) providing healthcare to an increasing number of middle-aged and older adults who remain at greater risk for chronic obstructive pulmonary disease (COPD) compared to their civilian counterparts. The VHA has obligated research funds, drafted clinical guidelines, and built programmatic infrastructure to support the diagnosis, treatment, and care management of Veterans with COPD. Despite these efforts, COPD remains a leading cause of morbidity and mortality in Veterans. This paper provides a narrative review of research conducted with US Veteran samples targeting improvement in COPD outcomes. We review key physiological, physical, and psychological health outcomes and intervention research that included US Veteran samples. We conclude with a discussion of directions for future research to continue advancing the treatment of COPD in Veterans and inform advancements in COPD research within and outside the VHA.
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Affiliation(s)
- Patricia M Bamonti
- Research & Development, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Emily S Wan
- Research & Development, VA Boston Healthcare System, Boston, MA, USA.,Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Marilyn L Moy
- Research & Development, VA Boston Healthcare System, Boston, MA, USA.,Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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7
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Tanaka T, Okita M, Jenkins S, Kozu R. Clinical and Psychological Impact of Chronic Pain in People with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:893-903. [PMID: 35497375 PMCID: PMC9043472 DOI: 10.2147/copd.s359223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/03/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose The presence of pain can be associated with an exaggerated negative cognitive and emotional response, leading to worsening of existing symptoms. This study aimed to describe the multifaceted impact of chronic pain on cognition, emotional and physical health in people with chronic obstructive pulmonary diseases (COPD) and to explore the clinical impact of pain. Patients and Methods A prospective, cross-sectional multicenter study was carried out in 68 people with COPD (COPD group) and 65 community-dwelling age-matched participants (control group). Participants were assessed for the presence of chronic pain, pain location, intensity and catastrophizing, pain-related fear (kinesiophobia), anxiety and depression, physical activity, and sleep duration. The COPD group also completed assessments of dyspnea, exercise tolerance (6-minute walk distance [6MWD]), and activities of daily living (ADL). Results The prevalence of pain was higher in the COPD group (85% vs 51%, p<0.001). The COPD group reported pain located in neck/shoulder, upper back, thorax and upper limbs, while the control group had more pain in the lower back. Pain catastrophizing and kinesiophobia were reported by 28% and 67% vs 9% and 42%, in the COPD and control groups respectively (both p<0.05). People with COPD and pain (n=58) reported greater dyspnea (p<0.001), and impairment in ADL (p<0.05), and lower 6MWD and physical activity (both p<0.01) compared to COPD participants without pain (n=10). Conclusion This study demonstrated that, compared to community-dwelling participants, there is a higher prevalence of chronic pain in people with COPD. Pain combined with dyspnea may impact adversely on cognitive function and lead to anxiety and depression, as well as greater impairment in exercise tolerance, physical activity, and ADL. These results suggested that it is necessary to assess the symptoms of chronic pain and inflect in chronic pain coping strategies.
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Affiliation(s)
- Takako Tanaka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Rehabilitation, Tagami Hospital, Nagasaki, Japan
- Correspondence: Takako Tanaka, Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan, Tel +81 95 819 7919, Fax +81 95 819 7919, Email
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sue Jenkins
- Institute for Respiratory Health and Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Ryo Kozu
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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8
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Clarke SY, Williams MT, Johnston KN, Lee AL. The prevalence and assessment of pain and dyspnoea in acute exacerbations of COPD: A systematic review. Chron Respir Dis 2022; 19:14799731221105518. [PMID: 35698999 PMCID: PMC9201350 DOI: 10.1177/14799731221105518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Dyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of examining prevalence, assessment, clinical associations, and researcher-reported implications of these symptoms. METHODS Four electronic databases were searched from inception to 31 May 2021. Full text versions of studies were assessed for methodological quality and data were extracted independently by two reviewers. Where data permitted, pooled prevalence of pain and dyspnoea were calculated by meta-analysis. RESULTS Four studies were included. The pooled prevalence of pain and dyspnoea was 44% (95% confidence interval (CI) 35%-52%) and 91% (95% CI 87%-94%) respectively. An array of instruments with varying focal periods were reported (pain: six tools, dyspnoea: four tools). Associations and clinical implications between the two symptoms at the time of hospital admission were rarely reported. CONCLUSIONS Few studies reported prevalence of pain and dyspnoea during an AECOPD. A greater understanding into the prevalence, intensity and associations of these symptoms during AECOPD could be furthered by use of standardised assessment tools with clearly defined focal periods.
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Affiliation(s)
- Stephanie Y Clarke
- Department of Physiotherapy, School
of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Frankston, Victoria, Australia
- Physiotherapy Department, Eastern Health, Victoria, Australia
| | - Marie T Williams
- IMPlementation And Clinical
Translation in Health (IIMPACT), Allied Health and Human Performance, University of South
Australia, Adelaide, South Australia, Australia
| | - Kylie N Johnston
- IMPlementation And Clinical
Translation in Health (IIMPACT), Allied Health and Human Performance, University of South
Australia, Adelaide, South Australia, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School
of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health
Sciences, Monash University, Frankston, Victoria, Australia
- Centre for Allied Health Research
and Education, Cabrini Health, Victoria, Australia
- Institute for Breathing and
Sleep, Victoria, Australia
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9
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Li LSK, Butler SJ, Ellerton L, Goldstein RS, Brooks D. Pain among Individuals with Chronic Respiratory Diseases Attending Pulmonary Rehabilitation. Physiother Can 2021; 73:304-312. [PMID: 34880534 DOI: 10.3138/ptc-2020-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study reports on the prevalence and impact of pain in individuals with different chronic respiratory diseases attending pulmonary rehabilitation (PR). Method: A retrospective review of medical records data was conducted for 488 participants who had attended a PR programme over a 2-year period. Data on pain and medication history taken from multidisciplinary medical records, together with participant demographics and PR outcomes, were extracted. We compared pain among participants with different types of chronic respiratory disease. Results: The overall prevalence of pain was 77%, with a significantly higher prevalence among individuals with obstructive lung diseases (80%) compared with restrictive lung diseases (69%; p = 0.04). Some participants (17%) who took pain medications did not discuss pain with their clinicians. The presence of pain and different reporting of pain did not have a negative impact on the PR programme completion rate (p = 0.74), improvements in exercise capacity (p = 0.51), or health-related quality of life (all four chronic respiratory disease questionnaire domains, p>0.05). Conclusions: The prevalence of pain is high among individuals with chronic respiratory disease attending PR. The presence or absence of pain was not negatively associated with the programme completion rate or PR outcomes; therefore, pain should not deter clinicians from referring patients to PR.
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Affiliation(s)
- Lok Sze Katrina Li
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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10
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Raphaely RA, Mongiardo MA, Goldstein RL, Robinson SA, Wan ES, Moy ML. Pain in Veterans with COPD: relationship with physical activity and exercise capacity. BMC Pulm Med 2021; 21:238. [PMID: 34266401 PMCID: PMC8280683 DOI: 10.1186/s12890-021-01601-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood. METHODS This retrospective secondary analysis includes three cohorts of Veterans with COPD who participated in longitudinal studies evaluating PA and exercise capacity with objective measures of daily step counts and 6-min walk test (6MWT) distance, respectively. Pain was assessed using the bodily pain domain of the Veterans RAND-36. In two cohorts, participants were randomly assigned to a web-based, pedometer-mediated PA intervention which has previously been demonstrated to improve PA. RESULTS Three-hundred and seventy-three (373) unique study participants were included in this analysis. Eighty-three percent (n = 311) of the population reported at least mild pain and/or at least a little bit of interference due to pain at baseline. Cross-sectionally, greater bodily pain was associated with lower 6MWT distance (β = 0.51; 95% CI 0.20, 0.82; p = 0.0013). Longitudinally, worsening bodily pain was associated with a decline in 6MWT distance (β = 0.30; 95% CI 0.03, 0.58; p = 0.0312). There was no association between baseline bodily pain and baseline daily step counts, baseline bodily pain and change in PA, or change in bodily pain and change in PA. Compared to usual care, our PA intervention improved bodily pain scores (β = 6.17; 95% CI 1.84, 10.45; p = 0.0054). Bodily pain scores did not affect the impact of the intervention on daily step counts. CONCLUSION Pain is highly prevalent and significantly associated with lower exercise capacity among Veterans with COPD. Worsening pain co-occurred with decline in exercise capacity but not PA. Our intervention reduced pain, although pain did not affect the impact of the intervention on PA.
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Affiliation(s)
- Rebecca A Raphaely
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Department of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
- Department of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria A Mongiardo
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Rebekah L Goldstein
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Stephanie A Robinson
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- VA Bedford Healthcare Systems, Bldg 70, 200 Springs Rd, Bedford, MA, 01732, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Emily S Wan
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA.
- Harvard Medical School, Boston, MA, USA.
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11
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Moy ML, Daniel RA, Cruz Rivera PN, Mongiardo MA, Goldstein RL, Higgins DM, Salat DH. Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging. PLoS One 2021; 16:e0254653. [PMID: 34265003 PMCID: PMC8282042 DOI: 10.1371/journal.pone.0254653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
Persons with COPD experience co-occurring dyspnea and pain. Little is known about the relationship between symptom co-occurrence with physical activity (PA) and exercise. Novel diagnostic tools are needed for accurate symptom discrimination. In this secondary analysis, we examined relationships between baseline assessments of pain, dyspnea, objectively measured PA, and exercise capacity in persons with COPD who previously enrolled in three PA studies. Pain was assessed with the bodily pain domain of the Veterans RAND-36 (VR-36), and dyspnea with the modified Medical Research Council (mMRC) scale. Average daily step count was assessed with the Omron HJ-720ITC or FitBit Zip pedometer, and exercise capacity with 6-minute walk test (6MWT). We also conducted a pilot neuroimaging study. Neuroimaging data were acquired on a Siemens 3-Tesla Magnetom Prismafit whole-body scanner. Analysis of variance assessed trends in daily step count and 6MWT distance across categories of co-occurring pain and dyspnea. General linear models examined relationships between cortical thickness and resting state functional connectivity (fc) with symptoms and functional status. In 373 Veterans, 98% were male with mean age 70.5± 8.3 years and FEV1% predicted 59 ± 21%. Compared to those with no co-occurrence of pain and dyspnea, those with co-occurrence walked 1,291–1,444 fewer steps per day and had an 80–85 m lower 6MWT distance. Ten males participated in the pilot neuroimaging study. Predominant findings were that lower cortical thickness and greater fc were associated with higher pain and dyspnea, p<0.05. Greater cortical thickness and lower fc were associated with higher daily step count and 6MWT distance, p<0.05. Regional patterns of associations differed for pain and dyspnea, suggesting that cortical thickness and fc may discriminate symptoms. Co-occurring dyspnea and pain in COPD are associated with significant reductions in PA and exercise capacity. It may be feasible for neuroimaging markers to discriminate between pain and dyspnea.
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Affiliation(s)
- Marilyn L. Moy
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Rinu A. Daniel
- Boston University School of Medicine, Boston, MA, United States of America
| | - Paola N. Cruz Rivera
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Maria A. Mongiardo
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Rebekah L. Goldstein
- Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - Diana M. Higgins
- Boston University School of Medicine, Boston, MA, United States of America
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America
| | - David H. Salat
- Harvard Medical School, Boston, MA, United States of America
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
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12
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Mori K, Tabusadani M, Yamane K, Takao S, Kuroyama Y, Matsumura Y, Ono K, Kawahara K, Omatsu S, Fujiwara K, Furuuchi K, Morimoto K, Kimura H, Senjyu H. Effects of pain on depression, sleep, exercise tolerance, and quality of life in patients with nontuberculous mycobacterial pulmonary disease. Medicine (Baltimore) 2021; 100:e26249. [PMID: 34115015 PMCID: PMC8202577 DOI: 10.1097/md.0000000000026249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
The experience and causes of pain in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) have not been clarified.This study aimed to determine the prevalence and severity of bodily pain (BP) in patients with NTM-PD. We also investigated the clinical indicators that contribute to pain.We used a retrospective cross-sectional study design. The participants were 114 NTM-PD patients (109 women) with a mean age of 65 years. The prevalence and severity of pain were measured using 2 items from the 36-Item Short Form Survey version 2 (SF-36), and the BP score was calculated. Functional limitation due to dyspnea was quantified using the Modified Medical Research Council Dyspnea Scale (mMRC), depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); health-related quality of life was assessed using the Leicester Cough Questionnaire (LCQ), and exercise tolerance was measured using the Incremental Shuttle Walk Test (ISWT).Pain was reported by 70.2% of the patients (n = 80), and of these, 35.7% (n = 25) reported moderate to very severe pain. NTM-PD patients with high levels of pain had significantly higher scores on the mMRC, CES-D, and PSQI scores, and significantly lower performance on the ISWT and LCQ. Multiple regression analysis identified ISWT, CES-D, and PSQI as independent factors that affected BP scores.Our findings suggest that pain significantly impacts daily life associated with reduced exercise tolerance, the presence of depressive symptoms, and poor sleep quality in patients with NTM-PD.
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Affiliation(s)
- Kosuke Mori
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Mitsuru Tabusadani
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Kazumasa Yamane
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Satoshi Takao
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Yuki Kuroyama
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Yusuke Matsumura
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Kazuki Ono
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Kazuma Kawahara
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Shunya Omatsu
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
| | - Keiji Fujiwara
- Respiratory Diseases Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
| | - Koji Furuuchi
- Respiratory Diseases Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
- Department of Basic Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Kozo Morimoto
- Respiratory Diseases Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
- Division of Clinical Research, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Hiroshi Kimura
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
- Respiratory Diseases Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo
| | - Hideaki Senjyu
- Department of Clinical Mycobacteriology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
- Respiratory Care and Rehabilitation Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association
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13
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Park SK. Frailty in Korean patients with chronic obstructive pulmonary disease, using data from the Korea National Health and Nutrition Examination Survey, 2015 and 2016. Appl Nurs Res 2021; 59:151417. [PMID: 33947511 DOI: 10.1016/j.apnr.2021.151417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
AIM To describe frailty, to identify its determinants, and to examine how it affected functioning in Korean patients with chronic obstructive pulmonary disease (COPD). This analysis was based on datasets from the Korea National Health and Nutrition Examination Survey (KNHANES). BACKGROUND Most of what is known about the prevalence and determinants of frailty in patients with COPD has come from countries other than Korea. Examining this issue with a representative sample of COPD patients in Korea will shed light on frailty in this population. METHODS This cross-sectional study, a secondary data analysis, used datasets from the KNHANES VI (2015) and VII (2016) to understand frailty in 417 patients with COPD (mean age = 65.36; FEV1%predicted value = 78.91). Demographic and clinical data, symptoms, self-rated health, frailty, and functioning were collected in health interviews and health examinations. Descriptive and inferential statistics were used to analyze the data. RESULTS One hundred forty-eight participants (35.5%) were frail, 156 (37.4%) were pre-frail, and 113 (27.1%) exhibited no frailty. Multivariate logistic regression showed that self-rated health, stage of COPD based on the Global Initiative for Chronic Obstructive Lung Disease, pain/discomfort, and arthritis were significant predictors of frailty. Multivariate logistic regression also showed that frail participants were more likely to experience limitations in usual activities, after controlling for other covariates. CONCLUSION Health care providers who know the determinants of frailty and its relationship with poor functioning will be better prepared to identify at-risk patients with COPD who might benefit from pulmonary rehabilitation.
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Affiliation(s)
- Soo Kyung Park
- College of Nursing, Korea University, 145 Anam-Ro, Seongbuk-gu, Seoul, Republic of Korea.
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14
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Hansen J, Molsted S, Ekholm O, Hansen H. Pain Prevalence, Localization, and Intensity in Adults with and without COPD: Results from the Danish Health and Morbidity Survey (a Self-reported Survey). Int J Chron Obstruct Pulmon Dis 2020; 15:3303-3311. [PMID: 33335391 PMCID: PMC7737012 DOI: 10.2147/copd.s275234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/06/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Pain is a clinical complication to chronic obstructive pulmonary disease (COPD) that interferes negatively with physical activity level (PAL), quality of life (QOL) and pulmonary interventions. Yet, research in pain characteristics including prevalence, localization, and intensity in people with COPD are sparsely researched. Aim To investigate self-reported pain prevalence, localization and intensity of pain in people with and without COPD, and to investigate the association between pain intensity and PAL among participants with COPD. Methods Data were derived from the Danish Health and Morbidity Survey in 2017. The study population was restricted to individuals aged ≥35 years. Data included pain intensity assessed on the Numeric Rating Scale (NRS) and localization, PAL, QoL, sleep disturbance, comorbidities, sociodemographic and behavioral factors. Results In all, 528 participants with COPD and 8184 participants without COPD (51% females, mean ±SD age 67.1±11.4 years) were analyzed. Pain prevalence within the past 14 days was significantly higher in participants with COPD vs nonCOPD (72.7% vs 57.7%, p<0.001) and mainly located in the limbs, thorax, and lower back. COPD was associated with the prevalence of chronic pain (≥6 months) (OR: 2.78, 95%CI: 2.32; 3.34, p<0.001). Participants with COPD reported a higher pain intensity compared to those with nonCOPD with a mean difference of 1.04 points (95%CI: 0.75; 1.32, p<0.001) on the NRS. In the adjusted multiple logistic regression analysis, pain intensity was negatively associated with odds of being physical active (OR: 0.72, 95%CI: 0.61; 0.85, p<0.001). Conclusion Pain is more prevalent in people with self-reported COPD. After adjustment for age and gender, COPD was associated with an elevated pain intensity. Sleep disturbance and multimorbidity had the most pronounced impacts on pain intensity in the multiple linear regression model. In participants with COPD, increased pain intensity was negatively associated with being physically active.
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Affiliation(s)
- Jeanette Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, University Hospital Hvidovre, Hvidovre, Denmark
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15
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Machado A, Marques A, Burtin C. Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach. Expert Rev Respir Med 2020; 15:131-142. [PMID: 33225762 DOI: 10.1080/17476348.2021.1854737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients' symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences. Areas covered: This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020. Expert opinion: Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms' management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.
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Affiliation(s)
- Ana Machado
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro , Aveiro, Portugal.,Institute of Biomedicine (Ibimed), University of Aveiro , Aveiro, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab 3R), School of Health Sciences (ESSUA), University of Aveiro , Aveiro, Portugal.,Institute of Biomedicine (Ibimed), University of Aveiro , Aveiro, Portugal
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Diepenbeek, Belgium.,BIOMED - Biomedical Research Institute, Hasselt University , Diepenbeek, Belgium
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16
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Bentsen SB, Holm AM, Christensen VL, Henriksen AH, Småstuen MC, Rustøen T. Changes in and predictors of pain and mortality in patients with chronic obstructive pulmonary disease. Respir Med 2020; 171:106116. [PMID: 32846337 DOI: 10.1016/j.rmed.2020.106116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 02/04/2023]
Abstract
This longitudinal study of patients with chronic obstructive pulmonary disease (COPD) aimed to investigate changes in pain characteristics (i.e., occurrence, intensity, and interference) and covariates associated with pain from study enrollment to 12 months, and to investigate if the different pain characteristics were associated with 5-year mortality. In total, 267 patients with COPD completed questionnaires five times over 1 year. The mean age of the patients was 63 years (standard deviation: 9.0), 53% were women, and 46% had very severe COPD. Median number of comorbidities was 2.0 (range: 0-11) and 47% of patients reported back/neck pain. Mixed models and Cox regression models were used for analyses. In total, 60% of the patients reported pain at baseline, and 61% at 12 months. The mixed model analyses revealed that those with better forced expiratory volume in 1 s (% predicted), more comorbidities, only primary school education, and more respiratory symptoms reported significantly higher average pain intensity. Moreover, those with more comorbidities, more respiratory symptoms, and more depression reported higher pain interference with function. At the 5-year follow-up, 64 patients (24%) were deceased, and the cumulative 5-year mortality rate was 22% (95% confidence interval [19-25]). Older age, lower forced expiratory volume in 1 s (% predicted), and higher pain interference at enrollment were all independently and significantly associated with higher 5-year mortality. Our findings show that many patients with COPD have persistent pain, and awareness regarding comorbidities and how pain interferes with their lives is needed.
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Affiliation(s)
- Signe B Bentsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Are M Holm
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Pb 4950, Nydalen, 0424, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway, Pb 1171, Blindern, 0318, Oslo, Norway.
| | - Vivi L Christensen
- Lovisenberg Diaconal University College, Lovisenberggt 15, 0456, Oslo, Norway.
| | - Anne H Henriksen
- Department of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, 7006, Norway; Department of Circulation and Medical Imaging, St Olav's University Hospital, Olav Kyrres Gate 17, 7030, Trondheim, Norway.
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevaal, Pb 4956, Nydalen, Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo Metropolitan University, Pb 4 St.Olavs Plass, Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevaal, Pb 4956, Nydalen, Oslo, Norway; Institute of Health and Society, Department of Nursing Science, University of Oslo, Nedre Ullevaal 9, Stjerneblokka, 0850, Oslo, Norway.
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17
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Helle T, Joho T, Kaptain RJ, Kottorp A. Activity repertoires and time use in people living with chronic obstructive pulmonary disease. Scand J Occup Ther 2020; 28:564-570. [PMID: 32631116 DOI: 10.1080/11038128.2020.1782982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation. AIM To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity. MATERIAL AND METHODS This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed. RESULTS Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (p < 0.05). No statistically significant difference in perceived competence, importance or enjoyment was found in relation to COPD severity. CONCLUSIONS AND SIGNIFICANCE Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.
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Affiliation(s)
- Tina Helle
- Department of Occupational Therapy, University College North, Aalborg, Denmark.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden
| | - Tanja Joho
- Zurich Psychiatric University Hospital, Zurich, Switzerland.,Department of Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rina Juel Kaptain
- Department of Occupational Therapy, University College North, Aalborg, Denmark.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden
| | - Anders Kottorp
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden.,Faculty of Health and Society, Malmö University, Malmö, Sweden
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18
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van Dam van Isselt EF, Groenewegen-Sipkema KH, van Eijk M, Chavannes NH, Achterberg WP. Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation. Chron Respir Dis 2020; 16:1479972318809456. [PMID: 30428718 PMCID: PMC6301839 DOI: 10.1177/1479972318809456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pain is a significant problem in stable chronic obstructive pulmonary disease (COPD) and is associated with other symptoms, worse health status and lower functional status. Not much is known about pain in unstable disease. The primary aim of the present study is to investigate prevalence, characteristics and relationships of pain in patients with COPD hospitalized for an acute exacerbation (AECOPD) and indicated for post-acute pulmonary rehabilitation (PR). This cross-sectional observational study included 149 patients (mean age 70.8 (±7.9) years, 49% male, mean forced expiratory volume in one second as percentage of predicted value 35.3 (±12.6)). Pain was assessed using the brief pain inventory. Functional status and health status were measured using the six-minute walking test (6MWT), the Barthel index (BI) and the clinical COPD questionnaire (CCQ), respectively. Pain was prevalent in 39.6% of all patients. Symptom burden was high, especially in patients with pain. Although we found no difference in objective measurements of functional status (6MWT, BI), patients with pain had clinically relevant lower health status (CCQ), attributed to the functional domain. Pain in patients hospitalized for AECOPD and indicated for post-acute PR is a relevant problem and needs more attention. Incorporation of standard pain assessment during exacerbations and post-acute PR is recommended.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- 1 Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.,2 Zorggroep Solis, Deventer, The Netherlands
| | | | - Monica van Eijk
- 1 Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Niels H Chavannes
- 1 Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilco P Achterberg
- 1 Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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19
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Recio Iglesias J, Díez-Manglano J, López García F, Díaz Peromingo JA, Almagro P, Varela Aguilar JM. Management of the COPD Patient with Comorbidities: An Experts Recommendation Document. Int J Chron Obstruct Pulmon Dis 2020; 15:1015-1037. [PMID: 32440113 PMCID: PMC7217705 DOI: 10.2147/copd.s242009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, which impact negatively on patients and are often underdiagnosed, thus lacking a proper management due to the absence of clear guidelines. Purpose To elaborate expert recommendations aimed to help healthcare professionals to provide the right care for treating COPD patients with comorbidities. Methods A modified RAND-UCLA appropriateness method consisting of nominal groups to draw up consensus recommendations (6 Spanish experts) and 2-Delphi rounds to validate them (23 Spanish experts) was performed. Results A panel of Spanish internal medicine experts reached consensus on 73 recommendations and 81 conclusions on the clinical consequences of the presence of comorbidities. In general, the experts reached consensus on the issues raised with regard to cardiovascular comorbidity and metabolic disorders. Consensus was reached on the use of selective serotonin reuptake inhibitors in cases of depression and the usefulness of referring patients with anxiety to respiratory rehabilitation programmes. The results also showed consensus on the usefulness of investigating the quality of sleep, the treatment of pain with opioids and the evaluation of osteoporosis by lateral chest radiography. Conclusion This study provides conclusions and recommendations that are intended to improve the management of the complexity of patients with COPD and important comorbidities, usually excluded from clinical trials.
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Affiliation(s)
- Jesús Recio Iglesias
- Internal Medicine Department, Quironsalud Valencia Hospital, Valencia, Valencian Community, Spain
| | - Jesús Díez-Manglano
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Aragon, Spain
| | - Francisco López García
- Internal Medicine Department General University Hospital of Elche, Alicante, Valencian Community, Spain
| | - José Antonio Díaz Peromingo
- Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, a Coruña, Galicia, Spain
| | - Pere Almagro
- Internal Medicine Department, Mútua Terrassa University Hospital, Terrassa, Barcelona, Catalonia, Spain
| | - José Manuel Varela Aguilar
- Internal Medicine Department, University Hospital Virgen del Rocío, Seville, Andalusia, Spain.,CIBER of Epidemiology and Public Health, Madrid, Community of Madrid, Spain
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20
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Viglino D, Maignan M. Aspects extrapulmonaires des exacerbations de bronchopneumopathie chronique obstructive. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La bronchopneumopathie chronique obstructive (BPCO) est une maladie systémique aux multiples atteintes, émaillée d’exacerbations. L’inflammation, l’hypoxémie, les troubles de la coagulation et les perturbations des interactions coeur–poumon expliquent en partie les atteintes non pulmonaires observées notamment lors d’exacerbations aiguës. Les événements cardiovasculaires sont la première cause de mortalité des patients BPCO, et leur recrudescence est observée pendant plusieurs semaines après une exacerbation. Aux urgences, la prise en charge des patients en exacerbation de BPCO repose donc en plus du support ventilatoire sur une bonne évaluation des potentielles pathologies associées telles que l’insuffisance cardiaque, l’ischémie myocardique, l’insuffisance rénale ou encore la maladie thromboembolique. Cette évaluation globale permet d’adapter les thérapeutiques parfois délétères sur la fonction cardiaque ou l’équilibre acide−base et de prendre en compte le risque extrapulmonaire dans le choix du parcours de soins du patient. Dans cette mise au point, nous abordons quelques explications physiologiques des multiples perturbations observées au cours de l’exacerbation de BPCO, et proposons une vision globale de l’évaluation de ces patients admis pour une dyspnée ou un autre motif pouvant être en rapport avec la BPCO.
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21
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Viglino D, Daoust R, Bailly S, Faivre-Pierret C, Charif I, Roustit M, Paquet J, Debaty G, Pépin JL, Maignan M, Chauny JM. Opioid drug use in emergency and adverse outcomes among patients with chronic obstructive pulmonary disease: a multicenter observational study. Sci Rep 2020; 10:5038. [PMID: 32193505 PMCID: PMC7081336 DOI: 10.1038/s41598-020-61887-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
There is still debate as to the safety of non-palliative opioid administration to chronic obstructive pulmonary disease (COPD) patients punctually treated for an acute complaint. All patients over 40 presenting at two university hospital emergency departments (Montréal Qc, Grenoble Fr) from March 2008 to September 2014 with dyspnea, abdominal pain or trauma were retrieved, and COPD patients were selected. Our primary endpoint was a composite criterion including invasive ventilation and death. Comparisons between visits in which opioid drugs were prescribed and those without opioids were performed using an inverse probability of treatment and censoring weight (IPTCW) estimator to adjust for baseline confounders. A survival weighted Cox model was used. 7799 visits by COPD patients were identified, corresponding to 4173 unique patients. Opioid drug prescription was reported in 1317 (16.9%) visits. After applying IPCTW weighting, opioid prescription was found to be associated with the composite criterion of poor clinical outcomes (HR = 4.73 (2.94; 7.61), p < 0.01). When taken separately, this association remained significant for invasive ventilation and death, but not for NIV. All sensitivity analyses confirmed the association, except for patients with trauma or abdominal pain as the main complaint. This excess risk is observed whatever the route of administration.
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Affiliation(s)
- Damien Viglino
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France. .,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.
| | - Raoul Daoust
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Sebastien Bailly
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Faivre-Pierret
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Isma Charif
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Matthieu Roustit
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
| | - Guillaume Debaty
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France.,Department of Physiology and Sleep, Grenoble Alpes University Hospital, Grenoble, France
| | - Maxime Maignan
- Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.,INSERM U1042, HP2 Laboratory, Grenoble-Alpes University, Grenoble, France
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Sacré-Coeur Hospital of Montreal, Montreal, Quebec, Canada
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Lee AL, Butler SJ, Varadi RG, Goldstein RS, Brooks D. The Impact of Pulmonary Rehabilitation on Chronic Pain in People with COPD. COPD 2020; 17:165-174. [PMID: 32131643 DOI: 10.1080/15412555.2020.1733952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Chronic pain affects up to 88% of people with chronic obstructive pulmonary disease (COPD) and has been associated with comorbidities. However, with pain not evaluated during pulmonary rehabilitation (PR) assessments, it is unclear whether PR impacts pain intensity and coping ability. This study aimed to 1) determine the effect of PR on pain qualities, coping behavior and psychological symptoms in those with COPD and chronic pain; and 2) assess the impact of PR on exercise capacity and quality of life in individuals with COPD and chronic pain compared to those without pain. Patients with COPD and comorbidities enrolling in outpatient PR were assessed for chronic pain. Those with chronic pain completed the Brief Pain Inventory, Coping Strategies Questionnaire-24, Fear Avoidance Behavior Questionnaire and measures of anxiety and depression. Changes in HRQOL and 6-minute walk distance (6MWD) following PR were compared between participants with and without chronic pain. Thirty-four participants with chronic pain and 34 participants without pain were included (mean ± SD, FEV1 47 ± 19% predicted). In those with chronic pain, PR did not affect pain intensity (median[IQR] pre/post PR 3[2-5] vs. 4[2-6] points, p = 0.21), anxiety (7[2-9] vs. 5[3-8] points, p = 0.82) or depression (4[2-8] vs. 3[1-6] points, p = 0.38) and did not change pain coping strategies. Both groups improved in 6MWD (mean difference [95% CI] 17[-39 to 72] m), and those without pain had greater improvement in mastery (p = 0.013). PR was effective in patients with moderate to severe COPD whether or not they reported chronic pain at the time of their initial assessment.
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Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.,Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Victoria, Australia.,Cabrini Health, Malvern, Victoria, Australia
| | - Stacey J Butler
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Robert G Varadi
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Roh JA, Kim KI, Park J, Lee BJ, Jung HJ. The efficacy of manual therapy (Chuna) for chronic obstructive pulmonary disease: Protocol for a systematic review. Medicine (Baltimore) 2020; 99:e18832. [PMID: 32118706 PMCID: PMC7478514 DOI: 10.1097/md.0000000000018832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a challenging disease whose prevalence has increased over the last decades. Non-pharmacological therapies such as pulmonary rehabilitation occupy a core position in patient management. Among these therapies, manual therapy reduces symptoms and increases exercise capacity targeting musculoskeletal problems. Chuna, a traditional Korean manual therapy, has improved pulmonary disorders in clinical practice but unfortunately has not had its effects reported. This systematic review aims to evaluate the effectiveness and safety of manual therapy, focused on the use of Chuna in the management of COPD patients. METHODS The following databases will be used in this study: MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Database (CNKI), KoreaMed, Korean Medical Database (KMbase), and Oriental Medicine Advanced Searching Integrated System (OASIS). The primary outcome comprises lung function and exercise capacity. Secondary outcomes included symptoms, quality of life, and adverse events. We will include randomized controlled trials (RCTs) and crossover studies. Two independent reviewers will screen the searched studies, determine if they are suitable for inclusion, and perform data extraction. The risk of bias will be assessed using the Cochrane risk of bias tool. When appropriate, data will be pooled across studies for meta-analysis using a fixed or random effects model. When quantitative synthesis is not appropriate, the evidence will be summarized qualitatively. RESULTS This study will provide a comprehensive review of the available evidence to assess the efficacy of Chuna for COPD patients. Results will be published in a peer-reviewed journal and disseminated electronically and in print. CONCLUSIONS This study will provide high-quality current evidence for evaluation the efficacy of Chuna for patients with COPD. Clinicians, patients and policy makers may find this review useful in making decisions regarding the use of Chuna for patients with COPD. PROSPERO REGISTRATION NUMBER CRD42019141150.
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Affiliation(s)
- Ji-Ae Roh
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Kwan-Il Kim
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Jihye Park
- Department of Biomedical Science and Technology, Graduate School, Kyung Hee University, Dongdaemun-gu, Seoul, Republic of Korea
| | - Beom-Joon Lee
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
| | - Hee-Jae Jung
- Department of Clinical Korean Medicine
- Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine
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Cheng W, Li X, Duan J, Zhou Z, Zhou A, Zhao Y, Zeng Y, Chen Y, Cai S, Chen P. Prevalence and Characteristics of Pain in Patients of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study in China. COPD 2020; 17:90-100. [PMID: 31948299 DOI: 10.1080/15412555.2020.1713076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purposes of this study were to: (1) study the prevalence of pain in patients with mild-to-very severe chronic obstructive pulmonary disease (COPD) in China; (2) compare the differences in pain characteristics between stable COPD and acute exacerbation of COPD (AECOPD); (3) explore the clinical associations with pain in those with COPD. This cross-sectional study was conducted in China from October 24, 2017, to January 11, 2019. A face-to-face interview was conducted to collect data. The Chinese version of the brief pain inventory (BPI-C) was applied to investigate the pain characteristics in patients with COPD. Of the 901 patients in this study, 226 (25.1%) patients reported pain problems. The prevalence of pain in patients with mild to very severe COPD was 32.9%, 23.9%, 25.2%, and 23.5%, respectively (p = 0.447). According to the BPI-C results, 31.3% (31/99) of patients reported pain of AECOPD, compared to 24.3% (195/802) of stable COPD (p = 0.13). Reported pain intensity and pain interference evaluated by the BPI-C were significantly higher in AECOPD than stable COPD (p < 0.001, p < 0.05, respectively). Those with body mass index (BMI) ≥ 24kg/m2 or COPD assessment test (CAT) score > 20 were significantly more likely to have pain problems than BMI < 24kg/m2 (aOR = 1.568, a95IC = 1.132-2.170, p = 0.007) or CAT ≤ 20 (aOR= 1.754, a95IC = 1.213-2.536, p = 0.003). Pain was common in patients with both stable COPD and AECOPD. AECOPD patients had a significantly higher pain intensity than stable COPD. Overweight and CAT > 20 were significantly related to higher prevalence of pain.
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Affiliation(s)
- Wei Cheng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Xiaoyun Li
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Jiaxi Duan
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Zijing Zhou
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Aiyuan Zhou
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yiyang Zhao
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yuqin Zeng
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Shan Cai
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
| | - Ping Chen
- Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital; Research Unit of Respiratory Disease; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, China
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Prevalence of Pain in COPD Patients and Associated Factors: Report From a Population-based Study. Clin J Pain 2019; 34:787-794. [PMID: 29485534 DOI: 10.1097/ajp.0000000000000598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine among Spanish adults with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients matched by age and sex; and to identify predictors for each of these types of pains among COPD sufferers. MATERIALS AND METHODS A cross-sectional study conducted with data collected from the European Health Interview Surveys for Spain (EHSS) conducted in years 2009/2010 (n=22,188) and 2014 (n=22,842). Data were analyzed using multivariable logistic models. RESULTS The prevalence of COPD among patients aged 35 years or above were 7.6% (n=1328) for the EHSS 2009 and 5.4% (n=1008) for the EHSS 2014. We matched 2251 COPD patients with age and sex controls. The prevalence of all types of pain were significantly higher among those suffering COPD than those without COPD. For CNP the figures were 40.5% versus 26.1%, for CLBP 44.8% versus 28.4%, and for migraine 22.5% versus 13.2%. Multivariable analysis showed that COPD was associated to a 1.21 (95% confidence interval [CI], 1.02-1.45) higher risk of CNP, 1.38 (95% CI, 1.16-1.64) of CLBP, and 1.36 (95% CI, 1.12-1.65) of migraine. Associated factors with the presence of these types of pain among COPD patients included younger age (not for CLBP), female sex (not for CLBP), "fair/poor/very poor" self-rated health (not for migraine), high blood pressure (not for CNP), mental disorders, obesity (not for migraine), and use of pain medication. DISCUSSION The prevalence of CNP, CLBP, and migraine was significantly higher among COPD patients in comparison with controls. Associated factors to suffering these types of pain in patients with COPD included age, sex, self-rated health, certain comorbidities including mental disorders, obesity, and using pain medication.
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Antoniu SA, Apostol A, Boiculese LV. Extra‐respiratory symptoms in patients hospitalized for a COPD exacerbation: Prevalence, clinical burden and their impact on functional status. CLINICAL RESPIRATORY JOURNAL 2019; 13:735-740. [DOI: 10.1111/crj.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II‐Nursing/Palliative Care University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Anca Apostol
- Faculty of Medicine University of Medicine and Pharmacy Grigore T Popa Iasi Romania
| | - Lucian Vasile Boiculese
- Department of Interdisciplinarity‐Biostatistics University of Medicine and Pharmacy Grigore T Popa Iasi Romania
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27
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Kraskovsky V, Schneider J, Mador MJ, Provost KA. Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital. J Palliat Care 2019; 37:125-133. [PMID: 31262230 DOI: 10.1177/0825859719851486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. OBJECTIVE To evaluate the utilization and impact of palliative care on the location of death and to identify clinical variables associated with palliative care contact. DESIGN Retrospective chart review from 2010 to 2016 at the VA Western New York Healthcare System using ICD-9/10 diagnosis of COPD. Palliative care contact was identified by Z51.5 or stop code 353. RESULTS Only 0.5% to 2% of living patients received palliative care, increasing abruptly at death (6%). Lower diffusion capacity for carbon monoxide (DLCO) (greater emphysema) was associated with palliative care contact, independent of comorbid disease burden or age. Initial outpatient contact was associated with a longer duration of palliative care (P = .003) and death in a home-like setting. Outpatient palliative care was associated with more severe airflow obstruction (forced expiratory volume in 1 second, percent predicted [FEV1%]), whereas greater disease exacerbation frequency was associated with inpatient contact. COPD patients not referred to palliative care had a greater comorbid disease burden, similar FEV1%, fewer disease exacerbations, and a greater DLCO. CONCLUSION Few patients with COPD received palliative care, similar to national trends. Initial outpatient palliative contact had the longest duration of care and death in the preferred home environment. The extent of emphysema (DLCO reduction) and more frequent disease exacerbations identified in patients were more likely to receive palliative care. Our study begins to define the benefits of palliative care in advanced COPD and confirms underutilization in the years before death, where a prolonged impact on the quality of life may be realized.
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Affiliation(s)
- Valeri Kraskovsky
- 1 Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jaclyn Schneider
- 2 Department of Geriatrics and Palliative Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,3 Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - M Jeffery Mador
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karin A Provost
- 4 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Health Administration, VA Western New York Healthcare System at Buffalo, Buffalo, NY, USA.,5 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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Pain during exacerbation of chronic obstructive pulmonary disease: A prospective cohort study. PLoS One 2019; 14:e0217370. [PMID: 31125359 PMCID: PMC6534306 DOI: 10.1371/journal.pone.0217370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background and objective Pain, a symptom often present in patients with Chronic Obstructive Pulmonary Disease (COPD), alters quality of life. COPD exacerbation augments several mechanisms that may cause pain (dyspnea, hyperinflation and inflammation) and therefore we hypothesized that pain might be increased during exacerbation. Methods A prospective cohort study was conducted in patients admitted for acute exacerbations of COPD (AECOPD) in two emergency departments in France and Canada. Patients with cancer-related pain or recent trauma were not included. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI) scale were used to evaluate pain intensity and location. Patients also completed the Borg Dyspnea Scale and Hospital Anxiety and Depression Scale. The questionnaires were completed again during an outpatient assessment in the stable phase. The primary outcome was difference in pain intensity (SF-MPQ) between the exacerbation and stable phases. Results Fifty patients were included. During exacerbation, 46 patients (92%) reported pain compared to 29 (58%) in the stable phase (p<0.001). Pain intensity was higher during exacerbation (SF-MPQ 29.7 [13.6–38.2] vs. 1.4 [0.0–11.2]; p<0.001). Pain was predominantly located in the chest during exacerbation and in the limbs during the stable phase. Pain intensity during exacerbation correlated with anxiety score. Conclusion The frequency and intensity of pain were higher during AECOPD, with a specific distribution. Pain should therefore be routinely assessed and treated in patients with AECOPD.
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Simonelli C, Vitacca M, Vignoni M, Ambrosino N, Paneroni M. Effectiveness of manual therapy in COPD: A systematic review of randomised controlled trials. Pulmonology 2019; 25:236-247. [PMID: 30738792 DOI: 10.1016/j.pulmoe.2018.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/20/2018] [Accepted: 12/15/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Manual therapy (MT) has been proposed in pulmonary rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD), but an updated systematic review of the evidence is lacking. We aimed to systematically review the effectiveness of MT interventions, alone or added to exercise, on lung function, exercise capacity and quality of life in COPD patients, compared to other therapies (e.g. exercise alone) or no treatment. MATERIALS AND METHODS We searched MEDLINE, EMBASE, Physiotherapy Evidence Database, and Cochrane Central Register of Controlled Trials databases, using the terms: COPD, manual therapy, manipulation, joint mobilisation, osteopathic manipulation. Only randomised controlled trials (RCT) were considered. RESULTS Out of 555 articles screened, 6 fulfilled the inclusion criteria. The study designs were heterogeneous (with different intervention schedules) and there was a high risk of bias. No effect on lung function was found, while results on exercise capacity were contrasting. MT had no effect on quality of life, although valid measures were available only in one study. Only mild adverse events were reported. CONCLUSIONS Few RCTs of poor methodological quality are available on the effects of MT in COPD. More and better quality RCTs are needed before this technique can be included in rehabilitation programmes for these patients.
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Affiliation(s)
- C Simonelli
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane (BS), Italy.
| | - M Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
| | - M Vignoni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano (PV), Italy
| | - N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano (PV), Italy
| | - M Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
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Lewthwaite H, Williams G, Baldock KL, Williams MT. Systematic Review of Pain in Clinical Practice Guidelines for Management of COPD: A Case for Including Chronic Pain? Healthcare (Basel) 2019; 7:healthcare7010015. [PMID: 30678205 PMCID: PMC6473434 DOI: 10.3390/healthcare7010015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD.
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Affiliation(s)
- Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Georgia Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Katherine L Baldock
- Australian Centre for Precision Health, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
| | - Marie T Williams
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia.
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ÖZEL A, TÜTÜN YÜMİN E, TUĞ T, SERTEL M. Effects of Quadriceps Muscle Strength and Kinesophobia On Health Related Quality of Life In Elderly Women and Men With Chronic Obstructive Pulmonary Disease. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.365860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen YW, HajGhanbari B, Road JD, Coxson HO, Camp PG, Reid WD. Reliability and validity of the Brief Pain Inventory in individuals with chronic obstructive pulmonary disease. Eur J Pain 2018; 22:1718-1726. [PMID: 29883526 DOI: 10.1002/ejp.1258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pain is prevalent in chronic obstructive pulmonary disease (COPD) and the Brief Pain Inventory (BPI) appears to be a feasible questionnaire to assess this symptom. However, the reliability and validity of the BPI have not been determined in individuals with COPD. This study aimed to determine the internal consistency, test-retest reliability and validity (construct, convergent, divergent and discriminant) of the BPI in individuals with COPD. METHODS In order to examine the test-retest reliability, individuals with COPD were recruited from pulmonary rehabilitation programmes to complete the BPI twice 1 week apart. In order to investigate validity, de-identified data was retrieved from two previous studies, including forced expiratory volume in 1-s, age, sex and data from four questionnaires: the BPI, short-form McGill Pain Questionnaire (SF-MPQ), 36-Item Short Form Survey (SF-36) and Community Health Activities Model Program for Seniors (CHAMPS) questionnaire. RESULTS In total, 123 participants were included in the analyses (eligible data were retrieved from 86 participants and additional 37 participants were recruited). The BPI demonstrated excellent internal consistency and test-retest reliability. It also showed convergent validity with the SF-MPQ and divergent validity with the SF-36. The factor analysis yielded two factors of the BPI, which demonstrated that the two domains of the BPI measure the intended constructs. The BPI can also discriminate pain levels among COPD patients with varied levels of quality of life (SF-36) and physical activity (CHAMPS). CONCLUSION The BPI is a reliable and valid pain questionnaire that can be used to evaluate pain in COPD. SIGNIFICANCE This study formally established the reliability and validity of the BPI in individuals with COPD, which have not been determined in this patient group. The results of this study provide strong evidence that assessment results from this pain questionnaire are reliable and valid.
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Affiliation(s)
- Y-W Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - B HajGhanbari
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - J D Road
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H O Coxson
- Department of Radiology, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - P G Camp
- Department of Physical Therapy, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - W D Reid
- Department of Physical Therapy, University of Toronto, ON, Canada.,Interdivisional Department of Critical Care Medicine, University of Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
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Bentsen SB, Miaskowski C, Cooper BA, Christensen VL, Henriksen AH, Holm AM, Rustøen T. Distinct pain profiles in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:801-811. [PMID: 29563780 PMCID: PMC5846750 DOI: 10.2147/copd.s150114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients. Objectives The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL). Patients and methods A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity. Results Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the "high probability of pain" group, while 29% were in the "moderate probability of pain" group. For the worst pain severity, 37% were in the "moderate pain" and 39% were in the "mild pain" groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale. Conclusion Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.
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Affiliation(s)
- Signe B Bentsen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Vivi L Christensen
- Department of Master and Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Anne H Henriksen
- Department of Circulation and Medical Imaging, St Olav’s University Hospital, Trondheim, Norway
| | - Are M Holm
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Chen YW, Coxson HO, Coupal TM, Lam S, Munk PL, Leipsic J, Reid WD. The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD). Respir Med 2018; 137:115-122. [PMID: 29605193 DOI: 10.1016/j.rmed.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history. METHOD Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints. RESULTS The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients. CONCLUSION Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - Harvey O Coxson
- Department of Radiology, and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Tyler M Coupal
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Stephen Lam
- Respiratory Division, Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology and Department of Medicine, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto Rehabilitation Institute, Interdivisional Department of Critical Care Medicine, Toronto, Canada
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Andenæs R, Momyr A, Brekke I. Reporting of pain by people with chronic obstructive pulmonary disease (COPD): comparative results from the HUNT3 population-based survey. BMC Public Health 2018; 18:181. [PMID: 29370850 PMCID: PMC5785865 DOI: 10.1186/s12889-018-5094-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 01/17/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is often associated with chronic pain, but pain in COPD remains poorly understood, particularly in comparison to pain in other groups. We compared the pain reported by people with COPD with that reported by arthritis, heart disease, diabetes, and those not reporting any disease, while adjusting for the effects of selected sociodemographic and lifestyle factors, comorbidities, anxiety, and depression. METHODS Using cross-sectional data from a population-based health survey in Norway (HUNT3; n = 50,807), we included participants with COPD (n = 1199), participants without COPD, but with arthritis (n = 8582), heart disease (n = 4109), or diabetes (n = 1254), and participants without any disease (n = 18,811). Logistic and linear regression analyses were performed to estimate the probability of reporting chronic pain and the level of pain intensity in the different groups adjusting for other relevant factors. RESULTS Approximately half (51.8%) of people with COPD reported chronic pain, which was a significantly higher rate than in the diabetes and non-disease groups, and similar to the heart disease group. People with arthritis had a chronic pain rate of 75.4%, which was higher than all other groups, including COPD. Analyses of pain intensity yielded similar findings, with the COPD group having higher pain intensity than the diabetes and non-disease groups, similar pain intensity as the heart disease group, and less pain intensity than the arthritis group. The likelihood of chronic pain and the intensity of pain were generally higher among women, people employed in occupations with low educational requirements, smokers, and those with comorbidity. Chronic pain rates and pain intensity increased with age and higher anxiety and depression scores, and were inversely related to physical activity. CONCLUSIONS People with COPD are at increased risk for chronic pain and higher pain intensity, second only to those with arthritis among the disease groups included in this study. The findings indicate a close relationship between pain and anxiety and depression. The relationships between pain and socioeconomic and lifestyle factors (e.g., smoking and exercise) suggest the need for efforts at the societal level to reduce inequality in health.
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Affiliation(s)
- Randi Andenæs
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St.Olavs plass, N-0130, Oslo, Norway.
| | - Astrid Momyr
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St.Olavs plass, N-0130, Oslo, Norway
| | - Idunn Brekke
- Faculty of Health Science, Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St.Olavs plass, N-0130, Oslo, Norway
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Bordoni B, Marelli F, Morabito B, Sacconi B, Caiazzo P, Castagna R. Low back pain and gastroesophageal reflux in patients with COPD: the disease in the breath. Int J Chron Obstruct Pulmon Dis 2018; 13:325-334. [PMID: 29403270 PMCID: PMC5777378 DOI: 10.2147/copd.s150401] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD) and low back pain (LBP) in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient’s care, improving the approach to the diaphragm muscle.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Scientific Institute of Hospitalization and Care, Milan
| | - Fabiola Marelli
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore.,Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Fano
| | - Bruno Morabito
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore.,Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Fano
| | - Beatrice Sacconi
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome.,Department of Radiological, Oncological and Anatomopathological Sciences, Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Rome
| | - Philippe Caiazzo
- Department of Osteopathic Research, AITOP, Italian Academy of Postural Osteopathic Therapy, Levizzano Rangone - Castelvetro, Italy
| | - Roberto Castagna
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore
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Lee AL, Harrison SL, Goldstein RS, Brooks D. An exploration of pain experiences and their meaning in people with chronic obstructive pulmonary disease. Physiother Theory Pract 2018; 34:765-772. [DOI: 10.1080/09593985.2018.1425512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Annemarie L Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Samantha L Harrison
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Chen YW, Camp PG, Coxson HO, Road JD, Guenette JA, Hunt MA, Reid WD. A Comparison of Pain, Fatigue, Dyspnea and their Impact on Quality of Life in Pulmonary Rehabilitation Participants with Chronic Obstructive Pulmonary Disease. COPD 2017; 15:65-72. [PMID: 29227712 DOI: 10.1080/15412555.2017.1401990] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In addition to dyspnea and fatigue, pain is a prevalent symptom in chronic obstructive pulmonary disease (COPD). Understanding the relative prevalence, magnitude, and interference with aspects of daily living of these symptoms can improve COPD management. Therefore, the purposes of this study were to: (1) compare the prevalence and magnitude of dyspnea, fatigue, and pain and how each limits aspects of daily living; (2) determine the association between pain and the other two symptoms; and (3) assess the impact of these symptoms on quality of life in COPD. Participants were recruited from pulmonary rehabilitation programs. Pain, dyspnea, and fatigue were measured using the Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI), and Dyspnea Inventory (DI), respectively. Quality of life was measured using the Clinical COPD Questionnaire (CCQ). The prevalence of dyspnea, fatigue, and pain were 93%, 77%, and 74%, respectively. Individuals with COPD reported similar severity scores of the three symptoms. Dyspnea interfered with general activity more than pain (F1.7,79.9 = 3.1, p < 0.05), whilst pain interfered with mood (F1.8, 82.7 = 3.6, p < 0.05) and sleep (F1,46 = 7.4, p < 0.01) more than dyspnea and fatigue. These three symptoms were moderately-to-highly correlated with each other (ρ = 0.49-0.78, p < 0.01) and all individually impacted quality of life. In summary, pain is a common symptom in addition to dyspnea and fatigue in COPD; all three interfere similarly among aspects of daily living with some exceptions. Accordingly, management of COPD should include a multifaceted approach that addresses pain as well as dyspnea and fatigue.
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Affiliation(s)
- Yi-Wen Chen
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - Pat G Camp
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Harvey O Coxson
- c Department of Radiology, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Jeremy D Road
- d Division of Respiratory Medicine, Department of Medicine , University of British Columbia , Vancouver , BC Canada
| | - Jordan A Guenette
- b Department of Physical Therapy, and Centre for Heart Lung Innovation , University of British Columbia , Vancouver , BC Canada
| | - Michael A Hunt
- a Department of Physical Therapy , University of British Columbia , Vancouver , BC Canada
| | - W Darlene Reid
- e Department of Physical Therapy , University of Toronto , Toronto , ON Canada
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Xiao T, Zhou X, He Y, Chen Y, Qiu H, Zhang S, Wei X, Wu K, Ruan X, Wang N, Fu C. Pain problems for patients with mild and moderate chronic obstructive pulmonary disease - a community-based study in Shanghai. J Pain Res 2017; 10:2247-2252. [PMID: 28979162 PMCID: PMC5608224 DOI: 10.2147/jpr.s141940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a great public health burden worldwide. Few studies have focused on pain problems in patients with mild and moderate COPD in Chinese community settings. METHODS A cross-sectional study of 283 patients with mild and moderate COPD was conducted in six communities that were randomly sampled in Pudong New Area of Shanghai, China, in 2016. A face-to-face interview was conducted to collect data on personal characteristics and health conditions. The short form McGill Pain Questionnaire and the COPD assessment test (CAT) were applied to evaluate pain problems and health status, respectively. RESULTS Among 283 subjects, more than one third (37%) had pain problems indicated by the present pain intensity (PPI) scale. COPD patients aged <65 years with exacerbation in the past 12 months or a CAT score of ≥10 had a significantly higher score in affective dimension. Female sex, COPD severity, and length of disease were significantly related to higher scores of the sensory dimension. Those with moderate COPD or a CAT score of ≥10 had significantly higher scores of visual analog scale than those with mild COPD or a CAT score <10. Patients with moderate COPD had a higher rank of PPI than those with mild COPD. CONCLUSION Pain was common in patients with mild and moderate COPD in the community settings of Shanghai, China. Severity of COPD and CAT score were significantly related to the prevalence of pain. Intervention measures should be developed to improve pain problems for COPD patients.
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Affiliation(s)
- Tian Xiao
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
| | - Xianfeng Zhou
- Department of Chronic Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Yun He
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hua Qiu
- Department of Chronic Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Sheng Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
| | - Xianglin Wei
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
| | - Kang Wu
- Department of Chronic Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Xiaonan Ruan
- Department of Chronic Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Na Wang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
| | - Chaowei Fu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Pudong Institute of Preventive Medicine, Fudan University
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Punekar YS, Riley JH, Lloyd E, Driessen M, Singh SJ. Systematic review of the association between exercise tests and patient-reported outcomes in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:2487-2506. [PMID: 28860743 PMCID: PMC5573061 DOI: 10.2147/copd.s100204] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is an increasingly common cause of death worldwide. Its cardinal symptoms include breathlessness and severely reduced exercise capacity. Several patient-reported outcome (PRO) measures are used to assess health-related quality of life (HRQoL), functional performance, and breathlessness in patients with COPD. Exercise testing is employed to measure functional performance objectively, which is generally believed to impact on overall HRQoL. However, the extent to which commonly used laboratory- and field-based exercise test results correlate with PROs has not been systematically assessed. Materials and methods A search of Embase, MedLine, and the Cochrane Library identified primary publications in English that reported data on the correlations (Pearson’s r or Spearman’s ρ) between the outcomes of exercise tests and HRQoL and breathlessness PROs. Studies reporting on the following tests were included: 6-minute walk test (6MWT), 12MWT, incremental and endurance shuttle walk tests, incremental and endurance cycle ergometer tests, and treadmill tests. Results Of 3,205 articles screened, 28 were deemed eligible for inclusion. The most commonly reported HRQoL PRO measure was the St George’s Respiratory Questionnaire (13 studies), and the most commonly reported breathlessness PRO measure was the Baseline Dyspnea Index (six studies). The St George’s Respiratory Questionnaire appears to correlate very weakly to moderately with the 6MWT, and breathlessness PROs appear to be moderately to strongly associated with 6MWT outcomes. Across all studies, the 6MWT was the most commonly reported exercise test. Very few publications reporting associations between other exercise tests and PRO measures were found. Conclusion This review found evidence to support the association of 6MWT outcomes with HRQoL and breathlessness PROs. There were limited data showing correlations with the outcomes of other exercise tests. Further work is required to examine the associations between these PROs and exercise test outcomes.
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Affiliation(s)
| | - John H Riley
- MDC Global Clinical Development UK, Respiratory Research and Development, GlaxoSmithKline, Uxbridge
| | - Emily Lloyd
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford
| | - Maurice Driessen
- MDC Global Clinical Development UK, Respiratory Research and Development, GlaxoSmithKline, Uxbridge
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
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Friis AL, Steenholt CB, Løkke A, Hansen M. Dietary beetroot juice - effects on physical performance in COPD patients: a randomized controlled crossover trial. Int J Chron Obstruct Pulmon Dis 2017; 12:1765-1773. [PMID: 28670117 PMCID: PMC5479267 DOI: 10.2147/copd.s135752] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background and objective Dietary beetroot juice (BR) supplementation has been shown to reduce the oxygen (O2) consumption of standardized exercise and reduce resting blood pressure (BP) in healthy individuals. However, the physiological response of BR in chronic obstructive pulmonary disease (COPD) remains controversial. The objective was to test exercise performance in COPD, supplementing with higher doses of BR for a longer duration compared to previous trials in this patient group. Methods Fifteen COPD patients consumed concentrated BR (2×70 mL twice daily, each containing 300 mg nitrate) or placebo (PL) (2×70 mL twice daily, nitrate-negligible) in a randomized order for 6 consecutive days. On day 7, participants consumed either BR or PL 150 min before testing. BP was measured before completing 6-minute walk test (6MWT) and two trials of submaximal cycling. The protocol was repeated after a minimum washout of 7 days. Results Plasma nitrite concentration was higher in the BR condition compared to PL (P<0.01). There was no difference between the BR and PL conditions regarding the covered distance during the 6MWT (mean ± standard error of the mean: 515±35 m (BR) vs 520±38 m (PL), P=0.46), O2 consumption of submaximal exercise (trial 1 P=0.31 vs trial 2 P=0.20), physical activity level (P>0.05), or systolic BP (P=0.80). However, diastolic BP (DBP) was reduced after BR ingestion compared to baseline (mean difference: 4.6, 95% CI: 0.1–9.1, P<0.05). Conclusion Seven days of BR ingestion increased plasma nitrite concentrations and lowered DBP in COPD patients. However, BR did not increase functional walking capacity, O2 consumption during submaximal cycling, or physical activity level during the intervention period.
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Affiliation(s)
- Anne Louise Friis
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark
| | | | - Anders Løkke
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Mette Hansen
- Section for Sport Science, Department of Public Health, Aarhus University, Denmark
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Lee AL, Goldstein RS, Brooks D. Chronic Pain in People With Chronic Obstructive Pulmonary Disease: Prevalence, Clinical and Psychological Implications. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2017; 4:194-203. [PMID: 28848931 PMCID: PMC5556911 DOI: 10.15326/jcopdf.4.3.2016.0172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 01/22/2023]
Abstract
Background: Although pain is a common symptom in chronic obstructive pulmonary disease (COPD), pain characteristics such as frequency, duration and type are unclear. The primary study aim was to identify these pain characteristics in individuals with COPD versus healthy control participants. The secondary aim was to explore the clinical and psychological associations with pain in those with COPD. Methods: Participants with COPD and age and gender-matched, healthy controls completed questionnaires to elicit pain characteristics. Those with COPD also had assessments of dyspnea, health-related quality of life, psychological associations (anxiety and depression) and physical activity. Results: Sixty-four participants with COPD (mean [standard deviation (SD)] age 71[10] , forced expiratory volume in 1 second [FEV1] 38% predicted) and 64 control participants (mean [SD] age 67 [13] , FEV1 91% predicted) were included. Chronic pain was more prevalent in individuals with COPD compared to control participants (41% versus 29%, p=0.03). The pain was more prevalent in the chest and upper back (p=0.04). COPD participants with chest or upper back pain had a higher total lung capacity (mean difference 2.0L, 95% confidence interval [CI] 0.6 to 3.0L) compared to COPD participants without pain. Greater dyspnea (p<0.001), more depression (p=0.02) and lower physical activity levels (p=0.03) were also present in people with COPD experiencing pain. Conclusions: Chronic pain is common in COPD. It is associated with higher dyspnea and depression and lower physical activity.
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Affiliation(s)
- Annemarie L. Lee
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Ontario, Canada
| | - Roger S. Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Ontario, Canada
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Gleeson A, Parry A, Higginson R. End-of-life prognostic indicators in patients with COPD: Part 1. Int J Palliat Nurs 2017; 22:508-514. [PMID: 27802088 DOI: 10.12968/ijpn.2016.22.10.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.
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Affiliation(s)
- Aoife Gleeson
- Consultant in Palliative Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach
| | - Andy Parry
- Senior Lecturer in Critical Care School of Care Sciences Glyntaf Campus University of South Wales
| | - Ray Higginson
- Senior Lecturer in Critical Care School of Care Sciences Glyntaf Campus University of South Wales
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Chen YW, Camp PG, Coxson HO, Road JD, Guenette JA, Hunt MA, Reid WD. Comorbidities That Cause Pain and the Contributors to Pain in Individuals With Chronic Obstructive Pulmonary Disease. Arch Phys Med Rehabil 2016; 98:1535-1543. [PMID: 27866992 DOI: 10.1016/j.apmr.2016.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine comorbidities that cause pain and the potential contributors to pain in individuals with chronic obstructive pulmonary disease (COPD). DESIGN Prospective cross-sectional survey study. SETTING Pulmonary rehabilitation programs of 6 centers. PARTICIPANTS A convenience sample of individuals with COPD (N=137) who attended pulmonary rehabilitation programs. In total, 100 (73%) returned the survey packages. Of those responders, 96 participants (70%) were included in the analyses. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain was measured using the Brief Pain Inventory. The questionnaire used to obtain information about health conditions that might contribute to pain and a medication record asked, in lay terms, about comorbidities that cause pain. The health conditions that cause pain were then validated by health professionals. Demographics, fatigue, dyspnea, quality of life, and self-efficacy were also measured using questionnaires. RESULTS Pain was reported in 71% (68/96) of participants. Low back pain was the most common location (41%). Arthritis (75%), back problems (47%), and muscle cramps (46%) were the most common comorbidities that caused pain. Lower self-efficacy, and renting rather than home ownership increased the likelihood of pain (P<.05). Pain severity and Brief Fatigue Inventory scores contributed to pain interference scores (P<.05). CONCLUSIONS Pain was highly prevalent in pulmonary rehabilitation program participants with COPD. The most common causes of pain were musculoskeletal conditions. Pain severity and higher levels of fatigue contributed to how pain interfered with daily aspects of living. The assessment and management of pain need to be addressed within the overall care of individuals with COPD.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy D Road
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Murphy SL, Schepens Niemiec S, Lyden AK, Kratz AL. Pain, Fatigue, and Physical Activity in Osteoarthritis: The Moderating Effects of Pain- and Fatigue-Related Activity Interference. Arch Phys Med Rehabil 2016; 97:S201-9. [PMID: 27207435 DOI: 10.1016/j.apmr.2015.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/07/2015] [Accepted: 05/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine how self-reported pain- and fatigue-related activity interference relates to symptoms and physical activity (PA) in daily life among people with knee or hip osteoarthritis. DESIGN Cross-sectional study with a 7-day repeated-measures assessment period. SETTING General community. PARTICIPANTS Participants (N=154; mean age, 65y; 60% women [n=92]) with knee or hip osteoarthritis and pain lasting ≥3 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain- or fatigue-related activity interference items on the Brief Pain Inventory or Brief Fatigue Inventory, respectively, from baseline survey, momentary pain and fatigue severity (measured 5times/d for 7d), and PA measured with a wrist-worn accelerometer over 7 days. We hypothesized that perception of pain- and fatigue-related activity interference would moderate the association between symptoms (pain or fatigue) and PA. People with higher pain- or fatigue-related activity interference were thought to have stronger negative associations between momentary ratings of pain and fatigue and PA than did those with lower activity interference. RESULTS Pain-related activity interference moderated the association between momentary pain and PA, but only in the first part of the day. Contrary to expectation, during early to midday (from wake-up time through 3 pm), low pain-related interference was associated with stronger positive associations between pain and PA but high pain-related interference was associated with a small negative association between pain and PA. Fatigue-related activity interference did not moderate the relation between fatigue and activity over the course of a day. CONCLUSIONS Depending on a person's reported level of pain-related activity interference, associations between pain and PA were different earlier in the day. Only those with high pain-related activity interference had lower levels of PA as pain increased and only in the morning. High pain-related activity interference may be important to address, particularly to maintain PA early in the day despite pain.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; VA Ann Arbor Health Care System (Geriatric Research, Education, and Clinical Center), Ann Arbor, MI.
| | - Stacey Schepens Niemiec
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Angela K Lyden
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease. Pain Manag Nurs 2016; 17:107-18. [PMID: 27095390 DOI: 10.1016/j.pmn.2016.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 12/31/2022]
Abstract
Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients.
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Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies. Contemp Clin Trials 2016; 47:172-84. [DOI: 10.1016/j.cct.2016.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/10/2016] [Accepted: 01/14/2016] [Indexed: 11/18/2022]
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Bordoni B, Marelli F, Bordoni G. A review of analgesic and emotive breathing: a multidisciplinary approach. J Multidiscip Healthc 2016; 9:97-102. [PMID: 27013884 PMCID: PMC4778783 DOI: 10.2147/jmdh.s101208] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The diaphragm is the primary muscle involved in breathing and other non-primarily respiratory functions such as the maintenance of correct posture and lumbar and sacroiliac movement. It intervenes to facilitate cleaning of the upper airways through coughing, facilitates the evacuation of the intestines, and promotes the redistribution of the body’s blood. The diaphragm also has the ability to affect the perception of pain and the emotional state of the patient, functions that are the subject of this article. The aim of this article is to gather for the first time, within a single text, information on the nonrespiratory functions of the diaphragm muscle and its analgesic and emotional response functions. It also aims to highlight and reflect on the fact that when the diaphragm is treated manually, a daily occurrence for manual operators, it is not just an area of musculature that is treated but the entire body, including the psyche. This reflection allows for a multidisciplinary approach to the diaphragm and the collaboration of various medical and nonmedical practitioners, with the ultimate goal of regaining or improving the patient’s physical and mental well-being.
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Affiliation(s)
- Bruno Bordoni
- Department of Cardiology, Santa Maria Nascente IRCCS, Milan, Don Carlo Gnocchi Foundation, Milan, Italy; Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy; Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Castellanza, Varese, Italy
| | - Fabiola Marelli
- Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy; Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Castellanza, Varese, Italy
| | - Giovannni Bordoni
- Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Falconara Marittima, Ancona, Italy; Department of Osteopathy, Centre de recherche d'emploi du Sud-Ouest (CRESO), Osteopathic Centre for Research and Studies, Castellanza, Varese, Italy
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Lee AL, Harrison SL, Goldstein RS, Brooks D. Pain and Its Clinical Associations in Individuals With COPD. Chest 2015; 147:1246-1258. [DOI: 10.1378/chest.14-2690] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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