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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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Presto P, Sehar U, Kopel J, Reddy PH. Mechanisms of pain in aging and age-related conditions: Focus on caregivers. Ageing Res Rev 2024; 95:102249. [PMID: 38417712 DOI: 10.1016/j.arr.2024.102249] [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: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.
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Affiliation(s)
- Peyton Presto
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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3
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Mookerjee N, Schmalbach N, Antinori G, Thampi S, Windle-Puente D, Gilligan A, Huy H, Andrews M, Sun A, Gandhi R, Benedict W, Chang A, Sanders B, Nguyen J, Keesara MR, Aliev J, Patel A, Hughes I, Millstein I, Hunter K, Roy S. Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population. J Prim Care Community Health 2024; 15:21501319241233463. [PMID: 38366930 PMCID: PMC10874592 DOI: 10.1177/21501319241233463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION/OBJECTIVE Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older. METHODS Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups. RESULTS Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P < .001), anxiety (27.0% vs 17.1%; P < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P = .036), obstructive sleep apnea (16.8% vs 11.6%; P = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P < .001), osteoarthritis (49.3% vs 26.1%; P < .001), other rheumatologic diseases (24.9% vs 19.4%; P = .006), and peripheral neuropathy (14.4% vs 5.3%; P < .001). CONCLUSION Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.
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Affiliation(s)
- Neil Mookerjee
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | | | - Amy Gilligan
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ha Huy
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Megha Andrews
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Angela Sun
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Roshni Gandhi
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Austin Chang
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ben Sanders
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Justin Nguyen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Janet Aliev
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Aneri Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Isaiah Hughes
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ian Millstein
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Satyajeet Roy
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Cooper University Health Care, Camden, NJ, USA
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Horner A, Olschewski H, Hartl S, Valipour A, Funk GC, Studnicka M, Merkle M, Kaiser B, Wallner EM, Brecht S, Lamprecht B. Physical Activity, Depression and Quality of Life in COPD - Results from the CLARA II Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2755-2767. [PMID: 38050481 PMCID: PMC10693753 DOI: 10.2147/copd.s435278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
Background Symptoms of depression, pain and limitations in physical activity may affect quality of life in COPD patients independent from their respiratory burden. We aimed to analyze the associations of these factors in outpatients with COPD in Austria in a stable phase of disease. Methods We conducted a national, cross-sectional study among patients with COPD. For depression, the Patient Health Questionnaire-9 (PHQ-9) and for respiratory symptoms the St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) were used along with 10-point scales for physical activity and pain. Results After exclusion of 211 patients due to non-obstructive spirometry or missing data, 630 patients (62.5% men; mean age 66.8 ± 8.6 (SD) years; mean FEV1%pred. 54.3 ± 16.5 (SD)) were analyzed. Of these, 47% reported one or more exacerbations in the previous year, 10.4% with hospitalization. A negative depression score was found in 54% and a score suggesting severe depression (PHQ-9 score ≥ 15) in 4.7%. In a multivariate linear regression model, self-reported pain, dyspnea, and number of exacerbations were predictors for higher PHQ-9-scores. A negative pain score was found in 43.8%, and a score suggesting severe pain in 2.9% (8-10 points of 10-point scale). Patients reporting severe pain were more often female, had more exacerbations, and reported more respiratory and depressive symptoms, a lower quality of life, and less physical activity. About 46% of patients rated their physical activity as severely impaired. These patients were significantly older, had more exacerbations, concomitant heart disease, a higher pain and depression score, and a lower quality of life (SGRQ-C - total score and all subscores). Conclusions In Austria, nearly half of stable COPD outpatients reported symptoms of depression, which were associated with lower levels of self-reported physical activity, more pain, and respiratory symptoms. The associations were particularly strong for depression with SGRQ-C.
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Affiliation(s)
- Andreas Horner
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, Klinik Penzing and Sigmund Freud University, Medical School, Vienna, Austria
| | - Arschang Valipour
- Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- Department of Internal and Respiratory Medicine, Klinik Ottakring, Vienna, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Monika Merkle
- Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria
| | - Bernhard Kaiser
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
| | | | | | - Bernd Lamprecht
- Johannes Kepler University Linz, Kepler University Hospital, Department of Pulmonology, Linz, Austria
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Loughran KJ, Tough D, Ryan CG, Wellburn S, Martin D, Dixon J, Harrison SL. The Association of Pain with Incident Falls in People with Chronic Obstructive Pulmonary Disease: Evidence from the English Longitudinal Study of Ageing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6236. [PMID: 37444084 PMCID: PMC10341239 DOI: 10.3390/ijerph20136236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/28/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
People with chronic obstructive pulmonary disease (COPD) have a higher prevalence of pain and a greater risk of falls than their healthy peers. As pain has been associated with an increased risk of falls in older adults, this study investigated the association between pain and falls in people with COPD compared to healthy controls. Data from the English Longitudinal Study of Ageing were used to establish an association between pain and falls when modelled with a generalised ordinal logistic regression and adjusted for sex, age, wealth, and education (complete case analysis only; n = 806 COPD, n = 3898 healthy controls). The odds were then converted to the predicted probabilities of falling. The predicted probability of falling for people with COPD was greater across all pain categories than for healthy controls; for COPD with (predicted probability % [95%CI]), no pain was 20% [17 to 25], with mild pain was 28% [18 to 38], with moderate pain was 28% [22 to 34] with severe pain was 39% [30 to 47] and for healthy controls with no pain was 17% [16 to 18], mild pain 22% [18 to 27], moderate pain 25% [20 to 29] and severe pain 27% [20 to 35]. The probability of falling increased across pain categories in individuals with COPD, with the most severe pain category at a nearly 40% probability of falling, indicating a potential interaction between COPD and pain.
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Affiliation(s)
- Kirsti J. Loughran
- Centre for Rehabilitation, School of Health & Life Science, Teesside University, Middlesbrough TS1 3BX, UK
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Scherer MJ, Kampe S, Fredebeul-Beverungen J, Weinreich G, Costabel U, Bonella F. Thoracic pain in patients with chronic interstitial lung disease-an underestimated symptom. Front Med (Lausanne) 2023; 10:1147555. [PMID: 37215705 PMCID: PMC10196162 DOI: 10.3389/fmed.2023.1147555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Prevalence and predisposing factors for the development of thoracic pain (TP) in patients with chronic interstitial lung disease (cILD) are largely unknown. Underestimation and insufficient therapy of pain can lead to worsened ventilatory function. Quantitative sensory testing is an established tool for characterization of chronic pain and its neuropathic components. We investigated frequency and intensity of TP in cILD patients and the potential association with lung function and quality of life. Materials and methods We prospectively investigated patients with chronic interstitial lung disease to analyze risk factors for the development of thoracic pain and quantify thoracic pain through quantitative sensory testing. In addition, we studied the relationship between pain sensitivity and lung function impairment. Results Seventy-eight patients with chronic interstitial lung disease and 36 healthy controls (HCs) were included. Thoracic pain occurred in 38 of 78 patients (49%), most frequently in 13 of 18 (72%, p = 0.02) patients with pulmonary sarcoidosis. The occurrence was mostly spontaneous and not related to thoracic surgical interventions (76%, p = 0.48). Patients with thoracic pain showed a significant impairment of mental well-being (p = 0.004). A higher sensitivity to pinprick stimulation during QST can be observed in patients with thoracic pain (p < 0.001). Steroid treatment was associated with lower sensitivity within thermal (p = 0.034 and p = 0.032) and pressure pain testing (p = 0.046). We observed a significant correlation between total lung capacity and thermal (p = 0.019 and p = 0.03) or pressure pain sensitivity (p = 0.006 and p = 0.024). Conclusion This study was performed to investigate prevalence, risk factors and thoracic pain in patients with chronic interstitial lung disease. Thoracic pain mostly occurs spontaneous as a frequent symptom, and seems to be an underestimated symptom in patients with chronic interstitial lung disease, especially those with pulmonary sarcoidosis. Timely identification of thoracic pain may allow starting symptomatic treatment at early stage, before impairment in quality of life occurs. Clinical Trial Registration https://www.drks.de/drks_web/, Deutsches Register Klinischer Studien (DRKS) DRKS00022978.
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Affiliation(s)
- Manuela J. Scherer
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Sandra Kampe
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jonas Fredebeul-Beverungen
- Department of Anaesthesiology and Pain Medicine, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Gerhard Weinreich
- Pneumology Department, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Ulrich Costabel
- Pneumology Department, Center for Interstitial and Rare Lung Diseases, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Francesco Bonella
- Pneumology Department, Center for Interstitial and Rare Lung Diseases, University Medicine Essen—Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
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König AN, Linkohr B, Peters A, Ladwig K, Laxy M, Schwettmann L. Relating the visceral factor of pain to domain‐specific risk attitudes. JOURNAL OF BEHAVIORAL DECISION MAKING 2023. [DOI: 10.1002/bdm.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Affiliation(s)
- Adriana N. König
- Munich School of Management and Munich Center of Health Sciences Ludwig‐Maximilians‐Universität München Munich Germany
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Institute for Medical Information Processing, Biometry and Epidemiology Ludwig‐Maximilians‐Universität München Munich Germany
- German Centre for Diabetes Research (DZD) Neuherberg Germany
| | - Karl‐Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar Technische Universität München (TUM) Munich Germany
| | - Michael Laxy
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
- German Centre for Diabetes Research (DZD) Neuherberg Germany
- Department of Sport and Health Sciences Technische Universität München Munich Germany
| | - Lars Schwettmann
- Department Environmental Health Helmholtz Zentrum München Neuherberg Germany
- Department of Health Services Research, School of Medicine and Health Sciences Carl von Ossietzky University of Oldenburg Oldenburg Germany
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8
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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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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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10
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Granados-Santiago M, Martín-Núñez J, Heredia-Ciuró A, Ortiz-Rubio A, Calvache-Mateo A, López-López L, Valenza MC. Cross-sectional study of pain-related variables before and during the COVID-19 pandemic in patients with COPD. Pain Manag Nurs 2022; 23:737-741. [PMID: 35725544 PMCID: PMC9135743 DOI: 10.1016/j.pmn.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic influences of COPD patients. The worsening of their health status may contribute to a higher pain prevalence. AIM The aim of this study was to analyze the pain-related variables before and during the COVID-19 pandemic in patients with chronic obstructive pulmonary disease. METHODS In this cross-sectional case-control study, stable patients with chronic obstructive pulmonary disease without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pronociceptive pain profile (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (perceived health status, anxiety, and depression). RESULTS Our results showed that patients with chronic obstructive pulmonary disease during COVID-19 pandemic experienced higher general pain sensitivity and intensity with statistical differences in pain interference (p < .001), being the overall perceived health status lower than before the pandemic (p < .05). CONCLUSIONS We concluded that patients with chronic obstructive pulmonary disease during the COVID-19 pandemic showed a rise the pronociceptive pain profile accompanied by increased psychological vulnerability.
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Affiliation(s)
| | - Javier Martín-Núñez
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain,Address correspondence to Laura López López, Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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11
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Kowalczys A, Bohdan M, Wilkowska A, Pawłowska I, Pawłowski L, Janowiak P, Jassem E, Lelonek M, Gruchała M, Sobański P. Comprehensive care for people living with heart failure and chronic obstructive pulmonary disease—Integration of palliative care with disease-specific care: From guidelines to practice. Front Cardiovasc Med 2022; 9:895495. [PMID: 36237915 PMCID: PMC9551106 DOI: 10.3389/fcvm.2022.895495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are the leading global epidemiological, clinical, social, and economic burden. Due to similar risk factors and overlapping pathophysiological pathways, the coexistence of these two diseases is common. People with severe COPD and advanced chronic HF (CHF) develop similar symptoms that aggravate if evoking mechanisms overlap. The coexistence of COPD and CHF limits the quality of life (QoL) and worsens symptom burden and mortality, more than if only one of them is present. Both conditions progress despite optimal, guidelines directed treatment, frequently exacerbate, and have a similar or worse prognosis in comparison with many malignant diseases. Palliative care (PC) is effective in QoL improvement of people with CHF and COPD and may be a valuable addition to standard treatment. The current guidelines for the management of HF and COPD emphasize the importance of early integration of PC parallel to disease-modifying therapies in people with advanced forms of both conditions. The number of patients with HF and COPD requiring PC is high and will grow in future decades necessitating further attention to research and knowledge translation in this field of practice. Care pathways for people living with concomitant HF and COPD have not been published so far. It can be hypothesized that overlapping of symptoms and similarity in disease trajectories allow to draw a model of care which will address symptoms and problems caused by either condition.
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Affiliation(s)
- Anna Kowalczys
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
- *Correspondence: Anna Kowalczys,
| | - Michał Bohdan
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alina Wilkowska
- Department of Psychiatry, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Iga Pawłowska
- Department of Pharmacology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Leszek Pawłowski
- Department of Palliative Medicine, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Piotr Janowiak
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Pomeranian, Poland
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Marcin Gruchała
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr Sobański
- Palliative Care Unit and Competence Centre, Department of Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
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12
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Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [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: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
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Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
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13
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Bartz-Overman C, Albanese AM, Fan V, Locke ER, Parikh T, Thielke S. Potential Explanatory Factors for the Concurrent Experience of Dyspnea and Pain in Patients with COPD. COPD 2022; 19:282-289. [PMID: 35666540 DOI: 10.1080/15412555.2022.2081540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Previous research has identified unexpectedly strong associations between dyspnea and pain, but the reasons remain unclear. Ascertaining the underlying biological and psychological mechanisms might enhance the understanding of the experience of both conditions, and suggest novel treatments. We sought to elucidate whether demographic factors, disease severity, psychological symptoms and biomarkers might account for the association between pain and dyspnea in individuals with COPD. We analyzed data from 301 patients with COPD who were followed in a prospective longitudinal observational study over 2 years. Measures included self-reported dyspnea and pain, pulmonary function tests, serum levels of inflammatory cytokines, measures of physical deconditioning, and scales for depression and anxiety. Analyses involved cross-sectional and longitudinal linear regression models. Pain and dyspnea were strongly correlated cross-sectionally (r = 0.77, 95% CI 0.72-0.82) and simultaneously across time (r = 0.42, 95% CI 0.28-0.56). Accounting for any of the other health factors only slightly mitigated the associations. Symptoms of pain and dyspnea thus may be fundamentally linked in COPD, rather than being mediated by common biological, psychological, or functional factors. From the patient's perspective, pain and dyspnea may be part of the same essential experience. It is possible that treatments for one condition would improve the other.
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Affiliation(s)
| | - Anita M Albanese
- University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Vincent Fan
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily R Locke
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Toral Parikh
- Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.,Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen Thielke
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry, University of Washington, Seattle, Washington, USA
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14
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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] [Key Words] [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
| | - 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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15
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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16
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Chaabouni M, Feki W, Moussa N, Bahloul N, Kammoun S. Chronic Pain in Patients with Chronic Obstructive Pulmonary Disease: A Cross Sectional Study. TANAFFOS 2022; 21:167-178. [PMID: 36879732 PMCID: PMC9985122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/10/2021] [Indexed: 03/08/2023]
Abstract
Background Many individuals with chronic obstructive pulmonary disease (COPD) report suffering from chronic pain, which affects their quality of life. This study aimed to determine the prevalence, characteristics and impact of chronic pain in patients with COPD, and to explore its possible predictive and aggravating factors. Materials and Methods It was a cross-sectional study. Male individuals with COPD responded to a questionnaire, including mMRC, CAT, Brief Pain Inventory (BPI) (composed of Worst pain, Pain Severity Score (PSS) and Pain Interference Score (PIS)), and Hospital Anxiety and Depression Scale. Patients were divided into group 1 (G1) with chronic pain, and group 2 (G2) without chronic pain. Results Sixty eight patients were included. The general prevalence of chronic pain was 72.1% (CI95%:10.7%). The most common site of pain was the chest (54.4%). Analgesics were used in 38.8%. Patients from G1 had more hospital admissions in the past (OR=6.4[1.7-23.4]). Three variables were associated to pain in the multivariate analysis: socio-economic level (OR=4.6[1.1-19.2]), hospital admissions (OR=0.087[0.017-0.45]), and CAT (OR=0.18[0.05-0.72]). Dyspnea was associated to PIS (p<0.005). A correlation was found between PSS and PIS (r=0.73). Six patients (8.8%) retired because of pain. Patients who had CAT≥10 were more in G1 (OR=4.9[1.6-15.7]). CAT was correlated to PIS (r=0.5). G1 demonstrated higher anxiety scores (p<0.05). There was a moderate positive correlation between depression symptoms and PIS (r=0.33). Conclusion Pain should be systematically assessed in COPD patients, regarding its high prevalence. New guidelines should take into consideration pain management to ameliorate patients' quality of life.
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Affiliation(s)
- Malek Chaabouni
- Department of Pulmonology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Walid Feki
- Department of Pulmonology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Nadia Moussa
- Department of Pulmonology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Najla Bahloul
- Department of Pulmonology, Hedi Chaker Hospital, Sfax, Tunisia
| | - Samy Kammoun
- Department of Pulmonology, Hedi Chaker Hospital, Sfax, Tunisia
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17
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Hume E. The concomitant assessment of pain and dyspnea in acute exacerbations of chronic obstructive pulmonary disease; is pain an understudied factor? Chron Respir Dis 2022; 19:14799731221105516. [PMID: 35699076 PMCID: PMC9201365 DOI: 10.1177/14799731221105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Emily Hume
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, 373117Northumbria University, Newcastle upon Tyne, UK
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18
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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: 2] [Impact Index Per Article: 1.0] [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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19
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Kupeli A, Bulut E, Unver E, Danisan G. The relationship between vertebral deformities and thoracic arthropathy with back pain in Chronic Obstructive Pulmonary Disease. Int J Clin Pract 2021; 75:e14953. [PMID: 34610196 DOI: 10.1111/ijcp.14953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/13/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate the relationship between back pain and thoracic vertebral deformities and arthropathy in patients with COPD who underwent thorax CT scans to screen for lung nodules and cancer. MATERIALS AND METHODS The data of patients who underwent thoracic CT and pulmonary function tests (PFTs) between July 2019 and February 2020 were retrospectively reviewed. The patients were divided into two groups: the COPD (n = 64) and control groups (n = 101), according to the PFT results. The CT images were evaluated for vertebral deformities, osteoporosis and thoracic vertebral joint arthropathy, and the Spinal Deformity Index (SDI) was calculated. RESULTS Back pain was detected in 43.7% of the COPD patients and 20.9% of the controls. The patients with COPD had significantly higher rates of costotransverse, intervertebral, facet joint arthropathy, and osteoporosis than did the control group (P < .001). The OR analyses showed that the presence of a vertebral deformity (OR 4.42, 95% CI 2.26 - 8.63, P < .001), of facet joint arthropathy (OR 3.6, 95% CI 2.83-4.58, P < .001), and of costotransverse arthropathy (OR 2.20, 95% CI 1.47-2.77, P < .001) were associated with the presence of back pain. Although a strong positive correlation was found between the SDI and pain score, a moderate negative correlation was found between the FEV1% values and pain score. CONCLUSIONS Back pain was present in patients with COPD and was related to vertebral deformities and facet and costotransverse joint arthropathy. Additional studies are required to clarify the relationships of back pain with musculoskeletal system diseases, including cervical and lumbar spine arthropathy and vertebral deformities.
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Affiliation(s)
- Ali Kupeli
- Department of Radiology, Faculty of Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Eser Bulut
- Department of Radiology, Faculty of Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ethem Unver
- Department of Chest Diseases, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Gurkan Danisan
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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20
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Xu Q, Wu K, Yang Y, Chang R, Qiu H, Wang Y, Lin T, Fu C, Chen Y, Wang N, Ruan X. Association Between Sleep Quality and Pain Intensity in Mild Patients with COPD: A Community Study. J Pain Res 2021; 14:2641-2649. [PMID: 34471380 PMCID: PMC8403565 DOI: 10.2147/jpr.s310036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose Poor sleep quality and pain were common and had been proved as an important influenced factor of quality of life for patients with COPD. The association of sleep quality with pain has been observed in other population but remains unclear in mild patients with COPD from a community setting. Methods A cross-sectional study was conducted to include eligible mild patients with COPD in Pudong New District of Shanghai. A structured questionnaire was used to collect general and clinical information for the patients. The Chinese version of Pittsburgh Sleep Quality Index (PSQI) and the short form of McGill Pain Questionnaire (SF-MPQ) was used to assess sleep quality and intensity of pain. Logistic regression was performed to test the association between sleeping quality and pain intensity. Results Two hundred and sixty-four patients with COPD, with an average age of 64 years (SD 5.78 years), were enrolled, and of 52% were women. Seventy-one (26.9%) participants reported at least one exacerbation during the past year. About 28.2% of the patients were classified as having poor sleep quality. Sleep quality was significantly associated with PRI score (adjusted odds ratio (ORad)=2.16, 95% CI: 1.16–4.00) and PPI rank (ORad=1.90, 95% CI: 1.08–3.34). People with daytime disturbance were more likely to have pain (ORad =2.03, 95% CI: 1.18–3.50). Conclusion Poor sleep quality was common in mild patients with COPD in community and was associated with higher pain intensity. Pain may involve an impairment of sleep quality.
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Affiliation(s)
- Qian Xu
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Kang Wu
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Yi Yang
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Rui Chang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Hua Qiu
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Yingying Wang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Tao Lin
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Chaowei Fu
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Na Wang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaonan Ruan
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
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21
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Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [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: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
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Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
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22
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Latiers F, Vandenabeele M, Poncin W, Reychler G. Prevalence and risk factors of musculoskeletal pain in patients with chronic obstructive pulmonary disease: A systematic review. CLINICAL RESPIRATORY JOURNAL 2021; 15:1286-1301. [PMID: 34459145 DOI: 10.1111/crj.13443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/14/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This systematic review aimed to discuss the prevalence and the risk factors of the musculoskeletal pain in chronic obstructive pulmonary disease (COPD). DATA SOURCE AND STUDY SELECTION Four databases were analysed (Scopus, PubMed, Cochrane and EMBASE). We excluded systematic reviews, meta-analyses, conference abstracts and case reports. Two authors independently checked for the eligibility of the relevant articles. The risk of bias was evaluated using the Newcastle Ottawa Quality Assessment Scale and the Joanna Briggs Institute critical appraisal checklist. The selection and evaluation of studies followed the PRISMA guidelines. RESULTS Twenty studies were retrieved, including from 21 to 7952 patients with COPD. The prevalence of pain was highly heterogeneous across studies: 7-89.7%. Pain was mostly reported in the lumbar (7-69%) and cervical spine (11-48.3%) and the chest (44-82.8%). The main risk factors for developing pain were old age, sex (female), level of physical activity (low) and comorbidities. CONCLUSION Pain is a very common symptom in patients with COPD. Despite this, few clinical trials have investigated the pain. It appears to be located primarily in the lumbar, cervical and thoracic regions and facilitated by being a female, a low level of physical activity, comorbidity(ies) and old age.
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Affiliation(s)
- Fabien Latiers
- Service de Chirurgie Thoracique et Vasculaire, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Marie Vandenabeele
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - William Poncin
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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23
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Singhvi DG, Nouraie M, Kessinger C, McMahon DK, Weinman R, Crothers K, Huang L, Bon J, Morris A, Merlin J. Brief Report: Association Between Pain, Pulmonary Function, and Respiratory Symptoms in People With HIV. J Acquir Immune Defic Syndr 2021; 87:1161-1166. [PMID: 33871410 PMCID: PMC8263479 DOI: 10.1097/qai.0000000000002696] [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: 07/30/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND People with HIV (PWH) experience chronic pain and respiratory symptoms, which are closely related in the general population. Pain may affect the impaired pulmonary function seen in PWH beyond its association with HIV alone. Our objective was to investigate the relationship of pain severity to pulmonary function, respiratory symptoms, and sleep disturbance in PWH. SETTING Study sites included the University of Pittsburgh, University of California San Francisco, and University of Washington. METHODS Pain, dyspnea, and sleep were assessed using the Brief Chronic Pain Questionnaire, St. George's Respiratory Questionnaire, and Pittsburgh Sleep Quality Index. Participants performed prebronchodilator and postbronchodilator spirometry and 6-minute walk test. Associations between pain severity, lung function, dyspnea, and sleep were assessed with bivariate and multiple quantile regression analysis adjusted for age, sex, race, body mass index, and smoking status. RESULTS Of 159 PWH, the median age was 56 years with 30.8% women. Two-thirds experienced pain in the past week, with 40.3% reporting chronic pain. Pain severity was higher with female sex (P = 0.038), non-White race (P = 0.005), current smoking (P = 0.003), and lower CD4+ count (P = 0.035). In adjusted analysis, higher pain severity was correlated with reduced postbronchodilator forced expiratory volume in 1 second %predicted (P = 0.008), reduced postbronchodilator forced vital capacity %predicted (P = 0.019), and chronic obstructive pulmonary disease (P = 0.032). Greater pain severity was strongly associated with a higher St. George's Respiratory Questionnaire score (P < 0.001) and sleep disturbance (P < 0.001). CONCLUSIONS In PWH, pain is common and associated with airflow obstruction, dyspnea, and sleep disturbance. Future studies assessing pain severity and pulmonary function over time could clarify the direction of this association and the impact on quality of life.
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Affiliation(s)
- Deepti G Singhvi
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Cathy Kessinger
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Renee Weinman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Kristina Crothers
- Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA
| | - Laurence Huang
- Division of HIV, Infectious Diseases, and Global Medicine and Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA
| | - Jessica Bon
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Medicine, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA; and
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Jessica Merlin
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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24
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Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R. Factors associated with pain at the end-of-life among older adults in Mexico. Public Health 2021; 191:68-77. [PMID: 33540186 DOI: 10.1016/j.puhe.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.
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Affiliation(s)
- R Samper-Ternent
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
| | | | - J D Zazueta
- Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands
| | - R Wong
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
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25
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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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26
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Fuentes-Alonso M, López-de-Andrés A, Palacios-Ceña D, Jimenez-Garcia R, Lopez-Herranz M, Hernandez-Barrera V, Perez-Farinos N, Ji Z, de-Miguel-Diez J. COPD is Associated with Higher Prevalence of Back Pain: Results of a Population-Based Case-Control Study, 2017. J Pain Res 2020; 13:2763-2773. [PMID: 33173326 PMCID: PMC7646454 DOI: 10.2147/jpr.s271713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to assess whether patients suffering from COPD have a higher prevalence of chronic back pain (neck and low back pain) than age-, sex-, and residence-matched non-COPD controls. We also aimed to identify which variables are associated with chronic neck pain (CNP) and chronic low back pain (CLBP) among COPD patients. Methods We carried out a retrospective case-control study using data obtained from the Spanish National Health Survey conducted in 2017. Results We analyzed data from 1034 COPD and 1034 matched non-COPD controls. The prevalence of CNP and CLBP was 38.20% and 45.16%, respectively, among COPD patients and 22.82% and 28.34% for non-COPD controls, respectively (p<0.001 for both). Multivariable analysis showed that COPD patients had a 1.62-fold (95% CI 1.50-1.74) higher risk of CNP and a 1.83-fold (95% CI 1.73-1.91) higher risk of CLBP than non-COPD controls. Experiencing one type of pain greatly increased the risk of having the other. Factors associated with the presence of both types of pain among COPD patients included female sex, "fair/poor/very poor" self-rated health, migraine or frequent headache and use of pain medication. Being aged from 70 to 79 years was a risk factor for CLBP, and suffering from a mental disorder was a risk factor for CNP. Conclusion The prevalence of CNP and CLBP was significantly higher among COPD patients than among non-COPD controls after adjusting for age, sex and other relevant clinical variables. Our findings add new data to the knowledge of chronic pain in COPD patients.
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Affiliation(s)
- Marta Fuentes-Alonso
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana López-de-Andrés
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Universidad Rey Juan Carlos, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Napoleon Perez-Farinos
- Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Málaga, Málaga, Spain
| | - Zichen Ji
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Javier de-Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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27
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Shen Q, Guo T, Song M, Guo W, Zhang Y, Duan W, Peng Y, Ni S, Ouyang X, Peng H. Pain is a common problem in patients with ILD. Respir Res 2020; 21:297. [PMID: 33176795 PMCID: PMC7659082 DOI: 10.1186/s12931-020-01564-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As it is less known about the prevalence and characteristics of pain in the patients with interstitial lung disease (ILD), this paper aims at determining the characteristics of the pain in the patients with ILD. METHODS Subjects with ILD and health controls with the matched ages and genders completed Short Form McGill Pain Questionnaire (SF-MPQ) and part of the Brief Pain Inventory (BPI) Short Form to elicit the characteristics of the pain. The patients with ILD were also assessed through Pulmonary Function Test, Six Minutes Walking Test (6MWT), modified Medical Research Council Dyspnea Scale (mMRC) for state of the illness and measured health-related quality of life (HRQoL) by Short Form-36 (SF-36) and psychological associations by Hospital Anxiety and Depression Scale (HADS). RESULTS A total of 63 subjects with ILD and 63 healthy controls (HC) were recruited in our study. The prevalence of the pain was 61.9% in ILD versus 25.3% in HC (P = 0.005) and the median score of the pain rank index (PRI) in ILD was higher than that in HC (P = 0.014). Chest (46.1%) accounted for the highest of overall pain locations in subjects with ILD. Associated clinical factors for pain intensity in the patients with ILD included exposure history of risk factors of ILD, with a longer distance of 6MWD (≥ 250 m), and a higher mMRC score (2-4). The patients with ILD and pain are more likely to suffer impaired HRQoL (P = 0.0014) and psychological problems (P = 0.0017, P = 0.044). CONCLUSION The pain is common in those with ILD and the pain intensity is associated with exposure history, 6MWD, and mMRC score. The patients with ILD and pain were possibly to suffer depression, anxiety, and impaired HRQoL.
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Affiliation(s)
- Qinxue Shen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Ting Guo
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Min Song
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Wei Guo
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yi Zhang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Wang Duan
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yating Peng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Shanshan Ni
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Xiaoli Ouyang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hong Peng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital of Central-South University, NO.139 Renmin Middle Road, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central-South University, Changsha, Hunan, People's Republic of China.
- The Respiratory Disease Diagnosis and Treatment Center of Hunan Province, Changsha, Hunan, People's Republic of China.
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28
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Jiménez-Trujillo I, López-de-Andrés A, Del Barrio JL, Hernández-Barrera V, Valero-de-Bernabé M, Jiménez-García R. Gender Differences in the Prevalence and Characteristics of Pain in Spain: Report from a Population-Based Study. PAIN MEDICINE 2020; 20:2349-2359. [PMID: 30789640 DOI: 10.1093/pm/pnz004] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the prevalence and characteristics of chronic neck pain, chronic low back pain, and migraine or frequent headaches among Spanish adults in 2014 according to gender, to identify predictors for each of these types of pains, and to compare the prevalence with those found in 2009. DESIGN Cross-sectional study. SETTING Spain. METHODS We used data collected from the 2014 European Health Interview Survey (N = 22,842). Sociodemographic features, self-rated health status, lifestyle habits, comorbid conditions, pain characteristics, and self-reported use of medications were analyzed. RESULTS The prevalence of all types of pain was significantly higher among women than men. For chronic neck pain, the figures were 25.68% vs 12.54%, for chronic low back pain, 27.03% vs 18.83%, and for migraine or frequent headaches, 15.93% vs 6.74%, in women and men, respectively. Predictors of these types of pain included female gender, advanced age, poor self-rated health, psychological distress, comorbidities, and obesity. The prevalence of neck pain and low back pain increased from 2009 to 2014 for both sexes, and the prevalence of migraine or frequent headaches remained stable over time. CONCLUSIONS The prevalence and intensity of all the forms of chronic pain were higher among women. Women experiencing pain used prescribed medications for pain, anxiety, and/or depression and sleeping pills more than men. The prevalence of chronic neck and low back has increased in the last five years in Spain, and the prevalence of migraine or frequent headaches has remained stable.
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Affiliation(s)
- Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - José Luis Del Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Marisa Valero-de-Bernabé
- Preventive Medicine and Public Health Department, Medicine Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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29
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Feder SL, Canavan ME, Wang S, Kent EE, Kapo J, Presley CJ, Ross J, Davidoff AJ. Patterns of Opioid Prescribing among Medicare Advantage Beneficiaries with Pain and Cardiopulmonary Conditions. J Palliat Med 2020; 24:195-204. [PMID: 32673139 DOI: 10.1089/jpm.2020.0193] [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: 01/14/2023] Open
Abstract
Background: Pain is common among patients with cardiopulmonary conditions; however, there are increasing concerns, but limited research, regarding use of opioids for pain in patients with noncancer conditions. Objective: To compare patterns of opioid prescribing among older adults reporting pain with cardiopulmonary conditions and/or cancer. Design: Observational study using data from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey resource linked to Medicare Part D prescription claims. Setting/Subjects: We identified patients who self-reported moderate-to-severe pain interference with daily activities. Patients were stratified by (1) self-reported history of cardiopulmonary conditions; (2) were within five years of cancer diagnosis; (3) had both conditions; or (4) neither. Measurements: We characterized opioid prescribing within 30 days of survey and one-year follow-up using logistic regression and Cox proportional hazard time-to-event analyses. Results: Of 10,516 patients with moderate-to-severe pain (1758 cardiopulmonary conditions, 3383 cancer, 2861 both, 2514 neither), 46% were aged ≥75 years, 65% were non-Hispanic white, and 10% non-Hispanic black. At survey, 1627 (15.5%) received opioids. Adjusted proportions of opioid use were lower for patients with cardiopulmonary conditions only (14%) compared with cancer only (17%; p < 0.001) and both conditions (17%; p < 0.001) but higher than patients with neither condition (13.1%; p < 0.001). There was no difference in time to initiation of opioids at follow-up among patients with cardiopulmonary conditions only, relative to cancer only (adjusted hazard ratio 1.03; 95% confidence interval 0.88-1.21). Conclusions: Opioid use is lower among patients with pain and cardiopulmonary conditions relative to patients with cancer. Findings emphasize the importance of pain assessment and management for patients with cardiopulmonary conditions.
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Affiliation(s)
| | - Maureen E Canavan
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shiyi Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA.,Yale School of Public Health, New Haven, Connecticut, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Kapo
- Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carolyn J Presley
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Joseph Ross
- Section of General Medicine and National Clinician Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Amy J Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA.,Yale School of Public Health, New Haven, Connecticut, USA
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30
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Bove DG, Lavesen M, Lindegaard B. Characteristics and health related quality of life in a population with advanced chronic obstructive pulmonary disease, a cross-sectional study. BMC Palliat Care 2020; 19:84. [PMID: 32552723 PMCID: PMC7301437 DOI: 10.1186/s12904-020-00593-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/15/2020] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND It is important to understand the total burden of COPD and thereby be able to identify patients who need more intensive palliative care to avoid deteriorated quality of life. The aim of this study was to describe the psychosocial and demographic characteristics of a population with advanced COPD in a stable phase of the disease. METHODS This study was cross-sectional based on a prospective observational cohort. The following questionnaires were administered: Chronic Respiratory Disease Questionnaire (CRQ), The COPD Assessment Test (CAT), The Hospital and Anxiety and Depression Scale (HADS), The Medical Research Council dyspnoea scale (MRC), and self-rate general health. RESULTS We included 242 patients with advanced COPD from a Danish pulmonary outpatient clinic. Their mean FEV1 was 38% (±12.7) and 19% were treated with long term oxygen. The mean CRQ domain score was CRQ-dyspnea 4.21 (±1.4), CRQ-Mastery 4.88 (±1.3), CRQ-Emotional 4.81 (±1.2), CRQ-Fatigue 3.93 (±1.3). The mean CAT-score was 18.4 (± 6.7), and 44% had a CAT score > 20. The mean score on the subscale for anxiety (HADS-A) and depression (HADS-D) was 5.07 (±3.9) and 5.77 (±3.9), respectively. Thirty percent self-rated their health as bad or very bad and 19.8% were current smokers. CONCLUSIONS This study describes the characteristics of a population with advanced COPD in a stable phase of their disease. Our results illustrate how the population although treated in an outpatient structure already focusing on palliative needs, still live with unmet palliative needs and impaired quality of life.
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Affiliation(s)
- D. G. Bove
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - M. Lavesen
- Emergency Department, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - B. Lindegaard
- Department of Pulmonary & Infectious Diseases, Copenhagen University Hospital, Nordsjælland, Dyrehavevej 29, 3400 Hillerød, Denmark
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31
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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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32
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Brown R, Nath S, Lora A, Samaha G, Elgamal Z, Kaiser R, Taggart C, Weldon S, Geraghty P. Cathepsin S: investigating an old player in lung disease pathogenesis, comorbidities, and potential therapeutics. Respir Res 2020; 21:111. [PMID: 32398133 PMCID: PMC7216426 DOI: 10.1186/s12931-020-01381-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 12/13/2022] Open
Abstract
Dysregulated expression and activity of cathepsin S (CTSS), a lysosomal protease and a member of the cysteine cathepsin protease family, is linked to the pathogenesis of multiple diseases, including a number of conditions affecting the lungs. Extracellular CTSS has potent elastase activity and by processing cytokines and host defense proteins, it also plays a role in the regulation of inflammation. CTSS has also been linked to G-coupled protein receptor activation and possesses an important intracellular role in major histocompatibility complex class II antigen presentation. Modulated CTSS activity is also associated with pulmonary disease comorbidities, such as cancer, cardiovascular disease, and diabetes. CTSS is expressed in a wide variety of immune cells and is biologically active at neutral pH. Herein, we review the significance of CTSS signaling in pulmonary diseases and associated comorbidities. We also discuss CTSS as a plausible therapeutic target and describe recent and current clinical trials examining CTSS inhibition as a means for treatment.
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Affiliation(s)
- Ryan Brown
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Sridesh Nath
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Alnardo Lora
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ghassan Samaha
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ziyad Elgamal
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Ryan Kaiser
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA
| | - Clifford Taggart
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Sinéad Weldon
- Airway Innate Immunity Research (AiiR) Group, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Patrick Geraghty
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, State University of New York Downstate Medical Centre, Brooklyn, NY, USA.
- Department of Cell Biology, State University of New York Downstate Medical Centre, Brooklyn, NY, USA.
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33
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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: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [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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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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35
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Oliveira A, Rutter M, Quijano-Campos JC, Herrero-Cortina B, Clari M, O'Rourke A, McGowan A, Burtin C, Sajnic A, De Brandt J. ERS International Congress, Madrid, 2019: highlights from the Allied Respiratory Professionals' Assembly. ERJ Open Res 2020; 6:00034-2020. [PMID: 32280669 PMCID: PMC7132037 DOI: 10.1183/23120541.00034-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/28/2020] [Indexed: 01/29/2023] Open
Abstract
This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals' Assembly during the European Respiratory Society International Congress 2019 in Madrid, Spain. Session content was mainly targeted at allied respiratory professionals such as respiratory physiologists, respiratory physiotherapists and respiratory nurses, and is summarised in this document. Short take-home messages related to pulmonary function testing highlight the importance of quality control. Furthermore, novel findings regarding the assessment of functional status call attention to bodily factors that can affect functional status. Regarding pulmonary rehabilitation, data were presented about the use of equipment and type of exercise training in COPD and lung cancer. Recent developments in physical activity-related research give insight in enablers of physical activity after hospital admission. The importance of integrated respiratory care was also highlighted, with the occupational therapist, nurse, and nutritional and psychological counsellor playing a pivotal role, which relates directly to research in the field of respiratory nursing that formulates the need for more nursing led-interventions in the future. To conclude, this review provides readers with valuable insight into some of the emerging and future areas affecting clinical practice of allied healthcare professionals. A highlights review of selected presentations from #ERSCongress 2019 by @ERS_Assembly9http://bit.ly/2VNFgAj
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Affiliation(s)
- Ana Oliveira
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,West Park Healthcare Centre, Toronto, Canada.,Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal.,These authors contributed equally
| | - Matthew Rutter
- Lung Function Dept, Cambridge University Hospitals, Addenbrookes Hospital, Cambridge, UK.,These authors contributed equally
| | - Juan Carlos Quijano-Campos
- Research and Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.,These authors contributed equally
| | - Beatriz Herrero-Cortina
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Universidad San Jorge, Zaragoza, Spain.,These authors contributed equally
| | - Marco Clari
- Dept of Public Health and Pediatrics, University of Turin, Turin, Italy.,These authors contributed equally
| | - Aoife O'Rourke
- Respiratory Dept, Cork University Hospital, Cork, Ireland.,These authors contributed equally
| | - Aisling McGowan
- Dept of Respiratory and Sleep Diagnostics, Connolly Hospital, Blanchardstown, Ireland
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreja Sajnic
- Dept for Respiratory Diseases Jordanovac, University Hospital Center Rebro, Zagreb, Croatia
| | - Jana De Brandt
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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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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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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41
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Wu M, Zan T, Zhao Q, Ge S, Li K, Li J. Symptom Clusters and Health-related Quality of Life in Chinese patients with Chronic Obstructive Pulmonary Disease. West J Nurs Res 2019; 42:437-445. [PMID: 31342864 DOI: 10.1177/0193945919866475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to identify symptom clusters of chronic obstructive pulmonary disease (COPD) and to examine the relationship between symptom clusters and health-related quality of life (HRQoL). It included 154 hospitalized patients with COPD. The majority of the participants (88.6%) were aged 60 years and above, and the numbers of men and women were approximately equal (men: 55.2%). The Charlson Comorbidity Index (CCI), the Memorial Symptom Assessment Scale (MSAS), and the Chinese version of the Clinical COPD Questionnaire (CCQ) were used to evaluate comorbidity, participant's symptoms, and HRQoL, respectively. Five symptom clusters were identified using exploratory factor analysis, and symptom clusters, especially the Psychological, Pain and Fatigue, GI, and Dyspnea-Sweat symptom clusters, had negative effects on HRQoL in patients with COPD. Understanding the patterns and occurrences of symptom clusters could be essential for developing effective interventions to manage COPD symptoms and improve the patients' HRQoL.
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Affiliation(s)
- Maochun Wu
- School of Nursing, Jilin University, Changchun, Jilin province, China.,Equal contributors
| | - Tao Zan
- Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.,Equal contributors
| | - Qiheng Zhao
- Orthopedics Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Song Ge
- Department of natural sciences and Nursing, University of Houston-Downtown, Houston, TX, USA
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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42
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Edwards H, Bennett M. Access to Opioids for Patients with Advanced Disease. Curr Pharm Des 2019; 25:3203-3208. [PMID: 31333089 DOI: 10.2174/1381612825666190716095337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
Abstract
Pain at the end of life is common in both malignant and non-malignant disease. It is feared by patients, their families and careers, and professionals. Effective pain control can be achieved for the majority of patients at the end of life using a multimodal approach. Pharmacological management relies predominantly on strong opioids. In spite of this, evidence suggests that under treatment of pain is common resulting in unnecessary suffering. Multiple barriers to use of opioids have been identified. Patient barriers include reluctance to report pain and to take analgesics. Professional barriers include inadequate pain assessment and lack of specialist knowledge and confidence in opioid therapy. Fear of side effects including respiratory depression affects patients and professionals alike. The impact of the "opioid epidemic", with increasing prescribed and illicit opioid use around the world, has also led to increasingly stringent regulation and concern about under prescribing in palliative care. System barriers to use of opioids at the end of life result from limited opioid availability in some countries and also inconsistent and limited access to palliative care. Multiple interventions have been developed to address these barriers, targeted at patients, professionals and systems. There is increasing evidence to suggest that complex interventions combining a number of different approaches are most effective in optimising pain outcomes for patients at the end of life.
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Affiliation(s)
- Helen Edwards
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
| | - Michael Bennett
- Academic Unit of Palliative Care, University of Leeds, Leeds, United Kingdom
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43
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Vardar-Yagli N, Saglam M, Calik-Kutukcu E, Inal-Ince D, Arikan H, Coplu L. Increased pain sensitivity, postural abnormalities, and functional balance impairment in obstructive lung disease compared to healthy subjects. Heart Lung 2019; 48:351-355. [PMID: 30655003 DOI: 10.1016/j.hrtlng.2018.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 12/29/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Naciye Vardar-Yagli
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Melda Saglam
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Hulya Arikan
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Lutfi Coplu
- Hacettepe University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
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44
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Self-management and health related quality of life in persons with chronic obstructive pulmonary disease. Qual Life Res 2019; 28:2889-2899. [DOI: 10.1007/s11136-019-02231-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 12/20/2022]
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45
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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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46
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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:E15. [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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Liu D, DiMeglio M, DiMartino M, Hajj J, Mukhanova M, Rai K, Winikor M, Laudanski K. Implications of Chronic Opioid Therapy on Perioperative Complications and Long-Term Surgical Recovery. TRANSLATIONAL PERIOPERATIVE AND PAIN MEDICINE 2019; 6:120-128. [PMID: 31528664 PMCID: PMC6746432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With chronic opioid use becoming an increasingly common occurrenceamong the general population, perioperative specialties must adapt to the physiologic changes caused by long-term opioids. However, data on the clinicalanesthetics implications of long-term opioid use is scarce. This review intends to survey the literature addressing the molecular mechanisms of long-term opioid use as well as their interaction with various organ systems.
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Affiliation(s)
- Da Liu
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew DiMeglio
- DO/MBA Student, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Michael DiMartino
- Department of Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jihane Hajj
- Department of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA,Department of Nursing, Widener University, Chester, PA, USA
| | - Maria Mukhanova
- Department of Biology, Drexel University, Philadelphia, PA, USA
| | - Karima Rai
- Department of Biology, Drexel University, Philadelphia, PA, USA
| | - Mazell Winikor
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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48
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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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49
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Jimenez-Garcia R, del Barrio JL, Hernandez-Barrera V, de Miguel-Díez J, Jimenez-Trujillo I, Martinez-Huedo MA, Lopez-de-Andres A. Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study. J Pain Res 2018; 11:1005-1015. [PMID: 29872337 PMCID: PMC5973317 DOI: 10.2147/jpr.s158877] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of the study was to study the association between low back pain (LBP), neck pain (NP), and diabetes while controlling for many sociodemographic characteristics, comorbidities, and lifestyle variables. The study also aimed to identify which of these variables is independently associated with LBP and NP among diabetes sufferers. METHODS A case-control study using data taken from the European Health Interview Surveys for Spain was conducted in 2009/2010 (n=22,188) and 2014 (n=22,842). We selected subjects ≥40 years of age. Diabetes status was self-reported. One non-diabetic control was matched by the year of survey, age, and sex for each diabetic case. The presence of LBP and NP was defined as the affirmative answer to both of the questions: "Have you suffered chronic LBP/NP over the last 12 months?" and "Has your physician confirmed the diagnosis?" Independent variables included demographic and socioeconomic characteristics, health status variables, lifestyles, and pain characteristics. RESULTS The prevalence of NP (32.2% vs 26.8%) and LBP (37.1% vs 30.3%) was significantly higher among those suffering from diabetes. Multivariable analysis showed that diabetes was associated with a 1.19 (95% CI 1.04-1.36) and 1.20 (95% CI 1.06-1.35) higher risk of NP and LBP. Among diabetic subjects, being female, concomitant mental or respiratory disorders, being obese, and physically inactive are variables associated with suffering from these pains. Those suffering NP had 8 times higher risk of reporting LBP than those without NP and the same association is found among those suffering from LBP. CONCLUSION The prevalence and intensity of NP and LBP are high among people with diabetes, affecting them significantly more than their age- and sex-matched non-diabetic controls. Specific preventive and educational strategies must be implemented to reduce the incidence, severity, and negative effect on the quality of NP and LBP among diabetic patients.
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Affiliation(s)
- Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - José Luis del Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentín Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Isabel Jimenez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | | | - Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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50
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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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