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Abstract
BACKGROUND Osteoporosis is a disorder of bone mineralisation occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. This is an updated version of a previous review. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Register of references (identified from electronic database searches and hand searches of journals and abstract books) on 5 May 2022. We performed additional searches of PubMed, clinicaltrials.gov and the WHO ICTRP (International Clinical Trials Registry Platform) on 5 May 2022. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Authors independently selected trials, extracted data and assessed risk of bias in included studies. Trial investigators were contacted to obtain missing data. We judged the certainty of the evidence using GRADE. MAIN RESULTS We included nine trials with a total of 385 participants (272 adults and 113 children (aged five to 18 years)). Trial durations ranged from six months to two years. Only two of the studies were considered to have a low risk of bias for all the domains. Bisphosphonates compared to control in people with cystic fibrosis who have not had a lung transplant Seven trials included only adult participants without lung transplants, one trial included both adults and children without lung transplantation (total of 238 adults and 113 children). We analysed adults (n = 238) and children (n = 113) separately. Adults Three trials assessed intravenous bisphosphonates (one assessed pamidronate and two assessed zoledronate) and five trials assessed oral bisphosphonates (one assessed risedronate and four assessed alendronate). Bisphosphonates were compared to either placebo or calcium (with or without additional vitamin D). Data showed no difference between treatment or control groups in new vertebral fractures at 12 months (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.09; 5 trials, 142 participants; very low-certainty evidence) and two trials (44 participants) reported no vertebral fractures at 24 months. There was no difference in non-vertebral fractures at 12 months (OR 2.11, 95% CI 0.18 to 25.35; 4 trials, 95 participants; very low-certainty evidence) and again two trials (44 participants) reported no non-vertebral fractures at 24 months. There was no difference in total fractures between groups at 12 months (OR 0.57, 95% CI 0.13 to 2.50; 5 trials, 142 participants) and no fractures were reported in two trials (44 participants) at 24 months. At 12 months, bisphosphonates may increase bone mineral density at the lumbar spine (mean difference (MD) 6.31, 95% CI 5.39 to 7.22; 6 trials, 171 participants; low-certainty evidence) and at the hip or femur (MD 4.41, 95% 3.44 to 5.37; 5 trials, 155 participants; low-certainty evidence). There was no clear difference in quality of life scores at 12 months (1 trial, 47 participants; low-certainty evidence), but bisphosphonates probably led to more adverse events (bone pain) at 12 months (OR 8.49, 95% CI 3.20 to 22.56; 7 trials, 206 participants; moderate-certainty evidence). Children The single trial in 113 children compared oral alendronate to placebo. We graded all evidence as low certainty. At 12 months we found no difference between treatment and placebo in new vertebral fractures (OR 0.32, 95% CI 0.03 to 3.13; 1 trial, 113 participants) and non-vertebral fractures (OR 0.19, 95% CI 0.01 to 4.04; 1 trial, 113 participants). There was also no difference in total fractures (OR 0.18, 95% CI 0.02 to 1.61; 1 trial, 113 participants). Bisphosphonates may increase bone mineral density at the lumbar spine at 12 months (MD 14.50, 95% CI 12.91 to 16.09). There was no difference in bone or muscle pain (MD 3.00, 95% CI 0.12 to 75.22), fever (MD 3.00, 95% CI 0.12 to 75.22) or gastrointestinal adverse events (OR 0.67, 95% CI 0.20 to 2.26). The trial did not measure bone mineral density at the hip/femur or report on quality of life. Bisphosphonates compared to control in people with cystic fibrosis who have had a lung transplant One trial of 34 adults who had undergone lung transplantation compared intravenous pamidronate to no bisphosphonate treatment. It did not report at 12 months and we report the 24-month data (not assessed by GRADE). There was no difference in the number of fractures, either vertebral or non-vertebral. However, bone mineral density increased with treatment at the lumbar spine (MD 6.20, 95% CI 4.28 to 8.12) and femur (MD 7.90, 95% CI 5.78 to 10.02). No participants in either group reported either bone pain or fever. The trial did not measure quality of life. AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates may increase bone mineral density in people with cystic fibrosis, but there are insufficient data to determine whether treatment reduces fractures. Severe bone pain and flu-like symptoms may occur with intravenous bisphosphonates. Before any firm conclusions can be drawn, trials in larger populations, including children, and of longer duration are needed to determine effects on fracture rate and survival. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids can ameliorate or prevent these adverse events. Future trials should also assess gastrointestinal adverse effects associated with oral bisphosphonates.
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Affiliation(s)
- Tomas C Jeffery
- Emergency Department, Queensland Health, Brisbane, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise S Conwell
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Australia
- Children's Health Queensland Clinical Unit, Greater Brisbane Clinical School, Medical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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2
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Dubin E, Lowers J, Dellon EP, Hempstead S, Faro A, Tallarico E, Fitzpatrick A, Hunt WR, Kavalieratos D. Prevalence of unmet pain and symptom management needs in adults with cystic fibrosis. J Cyst Fibros 2022; 22:352-355. [PMID: 35973901 DOI: 10.1016/j.jcf.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although people living with CF (PLwCF) commonly report pain and other symptoms, little is known regarding their experiences of living with and accessing treatment for burdensome symptoms. METHODS PLwCF completed online questionnaires assessing symptom prevalence and distress and were also asked about experiences accessing pain and symptom treatment, using both closed-ended and free-text entries. RESULTS Pain was the most prevalent symptom experienced among the 55 participants (76%) and the symptom that most commonly caused distress (64%). PLwCF not on CFTR modulator therapy were likelier to endorse pain as distressing (p = 0.007). Respondents expressed that their pain was commonly underrecognized and undermanaged, they desired a multi-modal approach to treatment, and noted concerns about disease progression affecting their symptom management options. CONCLUSIONS Our study suggests that PLwCF often have unmet symptom management needs that may impair quality of life.
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Affiliation(s)
- Ethan Dubin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Jane Lowers
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States
| | - Elisabeth P Dellon
- Department of Pediatrics, UNC Chapel Hill, Chapel Hill, NC, United States
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | | | - Anne Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - William R Hunt
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Dio Kavalieratos
- Rollins School of Public Health, Emory University, Atlanta, GA, United States; Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, United States; Department of Pediatrics, Emory University, Atlanta, GA, United States.
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3
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Schmoll A, Launois C, Perotin JM, Ravoninjatovo B, Griffon M, Carré S, Mulette P, Ancel J, Hagenburg J, Lebargy F, Deslée G, Salmon JH, Dury S. Prevalence and Impact of Rheumatologic Pain in Cystic Fibrosis Adult Patients. Front Med (Lausanne) 2022; 8:804892. [PMID: 35211488 PMCID: PMC8861186 DOI: 10.3389/fmed.2021.804892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background With the improvement of cystic fibrosis (CF) patient survival, the prevalence of long-term complications increased, among them rheumatologic disorders. Methods The aim of this prospective study was to evaluate the prevalence of spinal and joint pain, and their impact on disability, anxiety, depression, and quality of life in CF adult patients. Results Forty-seven patients were analyzed, 72% of men, mean aged 28 years, with a mean body mass index of 22 kg/m2 and a mean FEV1% of 63%. Twenty-two patients (47%) described rheumatologic pain either spinal (n = 15, 32%) and/or joint pain (n = 14, 30%). Patients with spinal and/or joint pain were shorter (p = 0.023), more frequently colonized with Staphylococcus aureus (p < 0.008), had more frequent ΔF508 homozygous mutations (p = 0.014), and a trend for more impairment of the 6-min walking distance (p = 0.050). The presence of rheumatologic pain tended to be associated with disability according to the Health Assessment Questionnaire (HAQ) and anxiety. Compared with patients with no pain patients with both spinal and joint pain exhibited a more pronounced impact on the St George's Respiratory Questionnaire (SGRQ). Conclusion Rheumatologic pain is frequent in CF adult patients, and may affect daily living, anxiety and quality of life. Systematic assessment of rheumatologic pain should be included in the management of CF patients.
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Affiliation(s)
- Axelle Schmoll
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Bruno Ravoninjatovo
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Muriel Griffon
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Sophie Carré
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Pauline Mulette
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean Hagenburg
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - François Lebargy
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,INSERM UMRS 1250, University of Reims Champagne-Ardenne, Reims, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Reims University Hospital, Reims, France.,EA3797, University of Reims Champagne-Ardenne, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
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Allgood S, Zemlak JL, Dellon E, Kapnadak SG, Goggin J, Lechtzin N. Satisfaction and effectiveness of opioid pain management among adults with cystic fibrosis: A mixed methods study. J Cyst Fibros 2022; 21:e15-e22. [PMID: 34257058 PMCID: PMC8743300 DOI: 10.1016/j.jcf.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic pain is common among people living with cystic fibrosis (CF) and associated with worse clinical outcomes. Despite this, little is known about how pain is managed and how opioids are used to treat pain. The purpose of this convergent mixed methods study was to examine self-reported satisfaction and effectiveness of pain management strategies among a sample of adults with CF who are prescribed opioids. METHODS We developed an online survey querying 4 domains - demographics, pain characteristics, pain communication, and management strategies. This was distributed nationally to adults with CF (n=48) via various online platforms. We obtained quantitative and qualitative responses regarding satisfaction and effectiveness of pain management. Emerged themes from qualitative data were compared with responses from quantitative survey domains. RESULTS Participants reported high levels of satisfaction and effectiveness with their opioid pain management plans. However, qualitative themes emerged regarding fears of addiction, experiences of feeling stigmatized by the healthcare system and ineffectiveness and inefficiency of alternative therapies for adequate pain relief. CONCLUSIONS Adults with CF reported opioids as an important component of their current pain management plans despite risks associated with opioid use. CF-specific pain management guideline development is warranted as is further research exploring pain development.
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Affiliation(s)
- Sarah Allgood
- Johns Hopkins University School of Nursing,Corresponding author. Funding acknowledgements: Ruth L. Kirschstein National Research Service Award, project period 7/1/03 – 6/30/18, #T32HL72748-15, Dr. Sharon McGrath-Morrow is the PI, (S. Allgood)
| | | | | | - Siddhartha G. Kapnadak
- University of Washington School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine
| | | | - Noah Lechtzin
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine
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Kapnadak SG, Ramos KJ, Dellon EP. Enhancing care for individuals with advanced cystic fibrosis lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S69-S78. [PMID: 32609949 DOI: 10.1002/ppul.24937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/09/2022]
Abstract
While remarkable advances in cystic fibrosis (CF) care have led to improvements in survival and quality of life, many individuals with CF are living with advanced cystic fibrosis lung disease (ACFLD) and others will face continued disease progression and its associated complex treatments and choices. This review will provide a summary of recently published guidelines for ACFLD care and lung transplant referral and highlight ongoing work to enhance the care of those with ACFLD through improvements in medical and psychosocial care, palliative care, and care around lung transplantation.
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Affiliation(s)
- Siddhartha G Kapnadak
- Division of Pulmonary, Department of Medicine, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Kathleen J Ramos
- Division of Pulmonary, Department of Medicine, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Elisabeth P Dellon
- Division of Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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6
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Yaoli Y, Trina H, Zubin M, Anita L, Catherine D, Andrew T B. Attitudes of pain and opioids prescription practices in U.S. cystic fibrosis centers. J Cyst Fibros 2020; 20:127-132. [PMID: 32798122 DOI: 10.1016/j.jcf.2020.07.021] [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] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The high incidence and prevalence of chronic pain in patients with cystic fibrosis (CF) is well documented. However, there is limited data on chronic pain management in this population. METHODS We designed a questionnaire examining care team members' views on the prevalence and characteristics of pain, pain management, and opioid use. The questionnaire was distributed to accredited programs throughout the US via a CF Foundation (CFF) email list-serve. RESULTS Responses came from 52 adult core or affiliated centers (Adult Responders - AR), 36 pediatric core or affiliated centers (Pediatric Responders - PR), and 9 were from combined programs. AR perceive more patients having chronic pain compared to PR. Furthermore, 40% of the AR said that > 50% of those with chronic pain also have comorbid depression or anxiety. 61% of PR ranked sinus/headache symptoms as the most common while AR ranked chest wall as the most frequent site (58%). While most centers (83%) report that pain management in patients with CF is a very important or important issue, 50% of AR feel uncomfortable or only slightly comfortable in prescribing opioids. 44% report that CF providers are currently responsible for this task. CONCLUSIONS Chronic pain is common in adult patients with CF and management presents a formidable challenge to providers. The development of guidelines and/or collaboration with pain specialists will likely benefit both patients and providers.
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Affiliation(s)
- Yang Yaoli
- Division of Pulmonary & Critical Care Medicine, University of Wisconsin. 600 Highland Ave, Madison, WI 53792 USA.
| | - Hollatz Trina
- St. Luke's Pulmonary Medicine Associates. 920 East First Street, Suite P201, Duluth, MN 55805 USA.
| | - Mukadam Zubin
- Division of Pulmonary & Critical Care Medicine, Wayne State University, 3990 John R St Suite-3 Hudson, Detroit, MI 48201 USA.
| | - Laxova Anita
- Cystic Fibrosis Clinical Trials Research Group, University of Wisconsin. K4/948 CSC, 600 Highland Ave, Madison, WI 53792 USA.
| | - Decker Catherine
- Division of Pulmonary and Critical Care Medicine, University of Wisconsin. 600 Highland Ave, Madison, WI 53792 USA.
| | - Braun Andrew T
- Division of Pulmonary & Critical Care Medicine, University of Wisconsin. 600 Highland Ave, Madison, WI 53792 USA.
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7
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Kapnadak SG, Dimango E, Hadjiliadis D, Hempstead SE, Tallarico E, Pilewski JM, Faro A, Albright J, Benden C, Blair S, Dellon EP, Gochenour D, Michelson P, Moshiree B, Neuringer I, Riedy C, Schindler T, Singer LG, Young D, Vignola L, Zukosky J, Simon RH. Cystic Fibrosis Foundation consensus guidelines for the care of individuals with advanced cystic fibrosis lung disease. J Cyst Fibros 2020; 19:344-354. [DOI: 10.1016/j.jcf.2020.02.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 12/25/2022]
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8
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Bell SC, Mainz JG, MacGregor G, Madge S, Macey J, Fridman M, Suthoff ED, Narayanan S, Kinnman N. Patient-reported outcomes in patients with cystic fibrosis with a G551D mutation on ivacaftor treatment: results from a cross-sectional study. BMC Pulm Med 2019; 19:146. [PMID: 31409396 PMCID: PMC6693259 DOI: 10.1186/s12890-019-0887-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/26/2019] [Indexed: 01/13/2023] Open
Abstract
Background Clinical studies demonstrate that ivacaftor (IVA) improves health-related quality of life (HRQoL) in patients aged ≥6 years with cystic fibrosis (CF). The real-world impact of IVA and standard of care (SOC) in groups of patients with G551D and F508del mutations, respectively, was assessed using a survey comprising disease-specific and generic HRQoL measures. Methods Patients with CF aged ≥12 years, or aged 6–11 years with caregiver support, with either (1) a G551D mutation and receiving IVA (G551D/IVA) for ≥3 months, or (2) homozygous for F508del and receiving SOC before lumacaftor/IVA availability (F508del/SOC), were eligible to participate in a cross-sectional survey. Demographic and clinical characteristics, and HRQoL measures were compared between patient groups, and multiple regression analyses were conducted. Results After differences in patient demographic and clinical characteristics were controlled for, significantly better scores were observed in the G551D/IVA group than in the F508del/SOC group on multiple domains of the validated Cystic Fibrosis Questionnaire-Revised and the EuroQol 5-dimensions 5-level questionnaire. Conclusions G551D/IVA patients reported better HRQoL than F508del/SOC patients on generic and disease-specific measures in a real-world setting.
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Affiliation(s)
- Scott C Bell
- Department of Thoracic Medicine, The Prince Charles Hospital and QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jochen G Mainz
- Jena University Hospital, Jena, Germany.,Brandenburg Medical School (MHB), University , Brandenburg an der Havel, Germany
| | | | | | - Julie Macey
- University Hospital Bordeaux, Bordeaux, France
| | | | | | | | - Nils Kinnman
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
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Trandafir LM, Leon MM, Frasinariu O, Baciu G, Dodi G, Cojocaru E. Current Practices and Potential Nanotechnology Perspectives for Pain Related to Cystic Fibrosis. J Clin Med 2019; 8:jcm8071023. [PMID: 31336857 PMCID: PMC6678759 DOI: 10.3390/jcm8071023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Pain is a complex, multidimensional process that negatively affects physical and mental functioning, clinical outcomes, quality of life, and productivity for cystic fibrosis (CF) patients. CF is an inherited multi-system disease that requires a complete approach in order to evaluate, monitor and treat patients. The landscape in CF care has changed significantly, with currently more adult patients than children worldwide. Despite the great advances in supportive care and in our understanding regarding its pathophysiology, there are still numerous aspects of CF pain that are not fully explained. This review aims to provide a critical overview of CF pain research that focuses on pain assessment, prevalence, characteristics, clinical association and the impact of pain in children and adults, along with innovative nanotechnology perspectives for CF management. Specifically, the paper evaluates the pain symptoms associated with CF and examines the relationship between pain symptoms and disease severity. The particularities of gastrointestinal, abdominal, musculoskeletal, pulmonary and chest pain, as well as pain associated with medical procedures are investigated in patients with CF. Disease-related pain is common for patients with CF, suggesting that pain assessment should be a routine part of their clinical care. A summary of the use of nanotechnology in CF and CF-related pain is also given. Further research is clearly needed to better understand the sources of pain and how to improve patients’ quality of life.
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Affiliation(s)
- Laura M Trandafir
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Magdalena M Leon
- Medical I Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Otilia Frasinariu
- Pediatric Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
| | - Ginel Baciu
- Pediatric Department, "Dunărea de Jos" University of Galati, 800008 Galati, Romania
| | - Gianina Dodi
- Advanced Centre for Research-Development in Experimental Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania.
| | - Elena Cojocaru
- Morpho-Functional Sciences Department, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
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10
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Liou TG, Adler FR, Argel N, Asfour F, Brown PS, Chatfield BA, Daines CL, Durham D, Francis JA, Glover B, Heynekamp T, Hoidal JR, Jensen JL, Keogh R, Kopecky CM, Lechtzin N, Li Y, Lysinger J, Molina O, Nakamura C, Packer KA, Poch KR, Quittner AL, Radford P, Redway AJ, Sagel SD, Sprandel S, Taylor-Cousar JL, Vroom JB, Yoshikawa R, Clancy JP, Elborn JS, Olivier KN, Cox DR. Prospective multicenter randomized patient recruitment and sample collection to enable future measurements of sputum biomarkers of inflammation in an observational study of cystic fibrosis. BMC Med Res Methodol 2019; 19:88. [PMID: 31027503 PMCID: PMC6485181 DOI: 10.1186/s12874-019-0705-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/11/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Biomarkers of inflammation predictive of cystic fibrosis (CF) disease outcomes would increase the power of clinical trials and contribute to better personalization of clinical assessments. A representative patient cohort would improve searching for believable, generalizable, reproducible and accurate biomarkers. METHODS We recruited patients from Mountain West CF Consortium (MWCFC) care centers for prospective observational study of sputum biomarkers of inflammation. After informed consent, centers enrolled randomly selected patients with CF who were clinically stable sputum producers, 12 years of age and older, without previous organ transplantation. RESULTS From December 8, 2014 through January 16, 2016, we enrolled 114 patients (53 male) with CF with continuing data collection. Baseline characteristics included mean age 27 years (SD = 12), 80% predicted forced expiratory volume in 1 s (SD = 23%), 1.0 prior year pulmonary exacerbations (SD = 1.2), home elevation 328 m (SD = 112) above sea level. Compared with other patients in the US CF Foundation Patient Registry (CFFPR) in 2014, MWCFC patients had similar distribution of sex, age, lung function, weight and rates of exacerbations, diabetes, pancreatic insufficiency, CF-related arthropathy and airway infections including methicillin-sensitive or -resistant Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia complex, fungal and non-tuberculous Mycobacteria infections. They received CF-specific treatments at similar frequencies. CONCLUSIONS Randomly-selected, sputum-producing patients within the MWCFC represent sputum-producing patients in the CFFPR. They have similar characteristics, lung function and frequencies of pulmonary exacerbations, microbial infections and use of CF-specific treatments. These findings will plausibly make future interpretations of quantitative measurements of inflammatory biomarkers generalizable to sputum-producing patients in the CFFPR.
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Affiliation(s)
- Theodore G. Liou
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Frederick R. Adler
- Departments of Mathematics, University of Utah, 155 South 1400 east, JWB 233, Salt Lake City, UT 84112 USA
- School of Biological Sciences, University of Utah, 257 South 1400 East, Salt Lake City, UT 84112 USA
| | - Natalia Argel
- Cystic Fibrosis Center, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Fadi Asfour
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Perry S. Brown
- St. Luke’s Cystic Fibrosis Center of Idaho, 610 W. Hays Street, Boise, ID 83702 USA
| | - Barbara A. Chatfield
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Cori L. Daines
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arizona Health Sciences, 1501 N. Campbell Avenue, Room 3301, PO Box 245073, Tucson, AZ 85724 USA
| | - Dixie Durham
- St. Luke’s Cystic Fibrosis Center of Idaho, 610 W. Hays Street, Boise, ID 83702 USA
| | - Jessica A. Francis
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Barbara Glover
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - Theresa Heynekamp
- Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care and Sleep Medicine, DoIM MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | - John R. Hoidal
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Judy L. Jensen
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Ruth Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Room G36, Keppel Street, London, WC1E 7HT UK
| | - Carol M. Kopecky
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline St, Baltimore, MD 21287 USA
| | - Yanping Li
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Jerimiah Lysinger
- Montana Cystic Fibrosis Center, Billings Clinic, 2800 10th Avenue N, Billings, MT 59101 USA
| | - Osmara Molina
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arizona Health Sciences, 1501 N. Campbell Avenue, Room 3301, PO Box 245073, Tucson, AZ 85724 USA
| | - Craig Nakamura
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - Kristyn A. Packer
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
| | - Katie R. Poch
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206 USA
| | - Alexandra L. Quittner
- Former: Department of Psychology, University of Miami, Miami, FL USA
- Present Address: Miami Children’s Research Institute, Nicklaus Children’s Hospital, 3100 SW 62nd Ave, Miami, FL 33155 USA
| | - Peggy Radford
- Cystic Fibrosis Center, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ 85016 USA
| | - Abby J. Redway
- Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care and Sleep Medicine, DoIM MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131 USA
| | - Scott D. Sagel
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 USA
| | - Shawna Sprandel
- Montana Cystic Fibrosis Center, Billings Clinic, 2800 10th Avenue N, Billings, MT 59101 USA
| | - Jennifer L. Taylor-Cousar
- Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, 1400 Jackson Street, Denver, CO 80206 USA
- Division of Pulmonology, Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO 80206 USA
| | - Jane B. Vroom
- Adult Cystic Fibrosis Center, Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, University of Utah, 26 North Mario Capecchi Drive, Salt Lake City, UT 84132 USA
- Intermountain Pediatric Cystic Fibrosis Center, Division of Pediatric Pulmonology, Department of Pediatrics, University of Utah, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Ryan Yoshikawa
- Cystic Fibrosis Center, 3006 S. Maryland Pkwy, Suite #315, Las Vegas, NV 89109 USA
| | - John P. Clancy
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3026 USA
| | - J. Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen’s University Belfast, 90 Lisburn Road, Belfast, BT9 6AG UK
| | - Kenneth N. Olivier
- Laboratory of Chronic Airway Infection, Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Drive MSC1454, Building 10-CRC, Room 1408A, Bethesda, MD 20892 USA
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Li SS, Tumin D, Krone KA, Boyer D, Kirkby SE, Mansour HM, Hayes D. Risks associated with lung transplantation in cystic fibrosis patients. Expert Rev Respir Med 2018; 12:893-904. [PMID: 30198350 DOI: 10.1080/17476348.2018.1522254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Survival after lung transplantation lags behind outcomes of other solid organ transplants, and complications from lung transplant are the second most common cause of death in cystic fibrosis. Evolving surgical techniques, therapeutics, and perioperative management have improved short-term survival after lung transplantation, yet have not translated into significant improvement in long-term mortality. Areas covered: We review risk factors for poor long-term outcomes among patients with cystic fibrosis undergoing lung transplantation to highlight areas for improvement. This includes reasons for organ dysfunction, complications of immunosuppression, further exacerbation of extrapulmonary complications of cystic fibrosis, and quality of life. A literature search was performed using PubMed-indexed journals. Expert commentary: There are multiple medical and socioeconomic barriers that threaten long-term survival following lung transplant for patients with cystic fibrosis. An understanding of the causes of each could elucidate treatment options. There is a lack of prospective, multicenter, randomized control trials due to cost, complexity, and feasibility. Ongoing prospective studies should be reserved for the most promising interventions identified in retrospective studies in order to improve long-term outcomes.
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Affiliation(s)
- Susan S Li
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Dmitry Tumin
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Katie A Krone
- b Division of Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA, OH , USA
| | - Debra Boyer
- b Division of Respiratory Diseases, Boston Children's Hospital , Harvard Medical School , Boston , MA, OH , USA
| | - Stephen E Kirkby
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
| | - Heidi M Mansour
- c Department of Pharmacology and Toxicology , The University of Arizona Colleges of Pharmacy and Medicine , Tucson , AZ , USA
| | - Don Hayes
- a Department of Pediatrics, Nationwide Children's Hospital , The Ohio State University College of Medicine , Columbus , OH , USA
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12
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Dellon EP, Helms SW, Hailey CE, Shay R, Carney SD, Schmidt HJ, Brown DE, Prieur MG. Exploring knowledge and perceptions of palliative care to inform integration of palliative care education into cystic fibrosis care. Pediatr Pulmonol 2018; 53:1218-1224. [PMID: 29862668 DOI: 10.1002/ppul.24073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) face the challenges of managing a chronic, progressive disease. While palliative care is a standard of care in serious illnesses, there are no guidelines for its incorporation into CF care. Patients with CF, caregivers, and CF care providers may lack knowledge about palliative care and perceive barriers to integrated care. OBJECTIVES To: 1) explore knowledge and perceptions of palliative care among patients with CF, caregivers, and CF care providers; 2) solicit opinions about incorporating palliative care into routine CF care; and 3) solicit recommendations for CF-specific palliative care education for patients and caregivers. METHODS We conducted semi-structured interviews with adult patients with CF, parents of adolescents with CF, and CF care providers to assess knowledge and perceptions of palliative care. Discussion included suggestions for palliative care education and integration into CF care. The sample was characterized using summary statistics. Key themes were identified using qualitative content analysis. RESULTS Ten patients with CF, ten parents, and eight CF care providers participated. Many had minimal knowledge of palliative care and endorsed the association with end of life as a barrier to palliative care, but after learning more about palliative care, thought it could be helpful, and should be introduced earlier. CONCLUSIONS In this single center study, many patients with CF, caregivers, and providers lacked knowledge about palliative care. These findings warrant replication in a larger, multisite study to inform palliative care educational interventions as a step toward consistent integration of palliative care into routine CF care.
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Affiliation(s)
- Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sarah W Helms
- Delores Barr Weaver Policy Center, Jacksonville, Florida
| | - Claire E Hailey
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Rosemary Shay
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott D Carney
- Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio
| | - Howard Joel Schmidt
- Department of Pediatrics, The Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - David E Brown
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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13
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Dellon E, Goggin J, Chen E, Sabadosa K, Hempstead S, Faro A, Homa K. Defining palliative care in cystic fibrosis: A Delphi study. J Cyst Fibros 2018; 17:416-421. [DOI: 10.1016/j.jcf.2017.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022]
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14
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Eyns H, De Wachter E, Malfroot A, Vaes P. Acute Pain Perception During Different Sampling Methods for Respiratory Culture in Cystic Fibrosis Patients. J Pain Symptom Manage 2018; 55:872-880. [PMID: 29154891 DOI: 10.1016/j.jpainsymman.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Reliable identification of lower respiratory tract pathogens is crucial in the management of cystic fibrosis (CF). The multitude of treatments and clinical procedures are a considerable burden and are potentially provoking pain. OBJECTIVES As part of another study (NCT02363764), investigating the bacterial yield of three sampling methods, nasal swabs (NSs), cough swabs (CSs), and (induced) sputum samples ([I]SSs), in both expectorating patients (EPs) and non-expectorating patients (NEPs) with CF, the present study aimed to explore the prevalence of respiratory culture sampling-related pain as assessed by self-report within a cohort of children and adults. METHODS Literate patients with CF (aged six years or older) completed a questionnaire on pain perception related to the three aforementioned sampling methods (No/Yes; visual analogue scale for pain [VAS-Pain] [0-10 cm]). In addition, patients were asked to rank these methods by their own preference without taking into account the presumed bacterial yield. RESULTS In total, 119 questionnaires were returned. In the EPs-group, CS was most frequently (n%; mean VAS-Pain if pain [range]) reported as painful method: overall (n = 101; 12.9%; 1.8 [0.2-4.8]), children (n = 41; 22.0%; 1.4 [0.2-2.7]), and adults (n = 60; 6.7%; 2.5 [0.5-4.8]). Highest pain intensity scores were observed with NS overall (3.0%; 2.4 [0.3-6.2]) and in children (4.9%; 3.3 [0.3-6.2]), but not in adults (1.7%; 0.6 [-]).NEPs-children (n = 17) reported ISS most frequently and as most painful sampling method (17.6%; 2.0 [1.0-4.0]). The only NEP-adult did not perceive pain. NEPs preferred NS > CS > ISS (61.1%, 33.3%, 5.6%, respectively [P = 0.001]) as primary sampling method, whereas EPs preferred SS > NS > CS (65.7%, 26.3%, 8.1%, respectively [P < 0.0001]). Patients' preference for a specific method inversely correlated to pain perception and intensity in EPs (φ = -0.155 [P = 0.007] and ρ = -0.926 [P = 0.008], respectively), but not in NEPs (φ = -0.226 [P = 0.097] and ρ = -0.135 [P = 0.798], respectively). CONCLUSION A relatively large range of pain experiences was observed in patients with CF during respiratory culture sampling, which underlines the importance of individual pain assessment. Nevertheless, clinicians can confidently choose the sampling method based on validity over patients' preference.
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Affiliation(s)
- Hanneke Eyns
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Elke De Wachter
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels
| | - Anne Malfroot
- Department of Paediatrics, Paediatric Pulmonology and Paediatric Infectious Diseases, Cystic Fibrosis Centre, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels
| | - Peter Vaes
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels; Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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15
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Allgood SJ, Kozachik S, Alexander KA, Thaxton A, Vera M, Lechtzin N. Descriptions of the Pain Experience in Adults and Adolescents with Cystic Fibrosis. Pain Manag Nurs 2018; 19:340-347. [PMID: 29501357 DOI: 10.1016/j.pmn.2017.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND People living with cystic fibrosis experience pain that is associated with decreased quality of life, poorer health outcomes, and increased mortality. Though pain is highly prevalent as a symptom, it is currently unknown how persons with CF describe their pain experiences or the ways those experiences impact their lives. AIMS To explore and describe ways adolescents and adults with CF experience pain. Design/Setting/Subjects/Methods: An exploratory descriptive design was implemented to perform interviews with 10 individuals with CF and self-reported moderate to severe pain. The interviews explored their pain experiences within five domains: Pain Characteristics, Activities, Relationships, Work/School Life, and Health Care Team. Transcribed interviews underwent a content analysis with team-based constant comparisons. RESULTS Individuals with CF identify the disease as being painful; express how pain negatively affects all aspects of their lives, including loss of functionality and productivity; and are able to disclose their pain to those with whom they have relationships. Adolescents feel an emotional toll from the loss of socialization as a result of pain and feel their health care team adequately supports their pain. Adults express a unique emotional pain component to CF and feel stigmatized and unsupported by their health care team when asking for pain management solutions. CONCLUSION There are differences in how pain is perceived by adolescents and adults with CF that have otherwise not been reported in the current literature. Further explorations of pain across the lifespan and health care provider attitudes toward pain management are needed to guide the development of effective pain management interventions for those with CF.
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Affiliation(s)
- Sarah J Allgood
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
| | - Sharon Kozachik
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Kamila A Alexander
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Abigail Thaxton
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Marc Vera
- Children's Hospital Vanderbilt, Nashville, Tennessee
| | - Noah Lechtzin
- Division of Pulmonary, Critical Care, and Sleep, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Systematic Review of Postural Assessment in Individuals With Obstructive Respiratory Conditions: MEASUREMENT AND CLINICAL ASSOCIATIONS. J Cardiopulm Rehabil Prev 2017; 37:90-102. [PMID: 27676462 DOI: 10.1097/hcr.0000000000000207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Changes in posture in individuals with an obstructive respiratory disease have been reported, but the extent of these deviations and their clinical significance is not well understood. This study aimed to systematically review the literature of the skeletal structural alignment in children and adults with an obstructive respiratory disease, describe the measurement techniques used, and determine the clinical relevance of any alternations. METHODS Observational cohort or cross-sectional studies of postural assessment were identified, with 2 reviewers independently assessing study quality. RESULTS A total of 18 studies were included, 12 in cystic fibrosis (CF), 5 in asthma, and 1 in chronic obstructive pulmonary disease (COPD). The overall quality assessment rating was 12.6 out of 16. Increased thoracic kyphosis or scoliosis was found in both children and adults with CF. Increased shoulder protraction and elevation were evident in asthma and COPD, although changes in spinal curvature were variable. The clinical impact of postural changes was diverse, with an inconsistent influence on lung function. A mix of methods was applied for postural assessment. CONCLUSIONS Skeletal structural malalignment appears to be present in some individuals with an obstructive respiratory disease, although the extent of alterations and its clinical impact is variable. Photogrammetry is used to provide a comprehensive assessment of posture in these populations.
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18
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Chen E, Homa K, Goggin J, Sabadosa KA, Hempstead S, Marshall BC, Faro A, Dellon EP. End-of-life practice patterns at U.S. adult cystic fibrosis care centers: A national retrospective chart review. J Cyst Fibros 2017; 17:S1569-1993(17)30873-1. [PMID: 28917611 DOI: 10.1016/j.jcf.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are many challenges to providing end-of-life care (EOLC) to people with cystic fibrosis (CF). METHODS Chart abstraction was used to examine EOLC in adults with CF who died between 2011 and 2013. RESULTS We reviewed 248 deaths from 71 CF care centers. Median age at death was 29years (range 18-73). While median FEV1 was in the severe lung disease category (FEV1<40%), 38% had mild or moderate lung disease in the year preceding death. The most common location of death was the intensive care unit (ICU, 39%), and 12% of decedents were listed for lung transplant. Fewer of those dying in the ICU personally participated in advance care planning or utilized hospice or Palliative Care Services (p<0.05). CONCLUSIONS Adults dying with CF in the United States most commonly die in an ICU, with limited and variable use of hospice and Palliative Care Services. Palliative care and advance care planning are recommended as a routine part of CF care.
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Affiliation(s)
- Elaine Chen
- Rush University Medical Center, Chicago, IL, United States.
| | - Karen Homa
- Independent Consultant, Orford, NH, United States
| | | | - Kathryn A Sabadosa
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Elisabeth P Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
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Lechtzin N, Allgood S, Hong G, Riekert K, Haythornthwaite JA, Mogayzel P, Hankinson J, Yaster M. The Association Between Pain and Clinical Outcomes in Adolescents With Cystic Fibrosis. J Pain Symptom Manage 2016; 52:681-687. [PMID: 27693896 DOI: 10.1016/j.jpainsymman.2016.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 02/25/2016] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
Abstract
CONTEXT Pain is a common problem in patients with cystic fibrosis (CF) and in adults is associated with lower quality of life and more pulmonary complications. Less is known about the impact of pain in adolescents with CF. OBJECTIVES This study aimed to describe pain in an adolescent CF population and to determine if pain at baseline is associated with lower health-related quality of life (HRQoL) and worse pulmonary outcomes at six-month follow-up. METHODS We administered surveys at baseline and at six months to CF patients aged 12 to 20 years. Analyses included Wilcoxon log-rank tests, Spearman correlations, and linear and logistic regressions. RESULTS Seventy-three patients (86.9%) completed the baseline questionnaire and 53 patients (63.1%) completed the six-month follow-up questionnaire. Mean age was 15.6 ± 2.5 and mean FEV1 was 79 ± 26% predicted; 89% of patients reported pain in the three months before the survey, but in most it was short lived and mild to moderate in severity. Abdominal pain was the most common location. Pain was associated with increased pulmonary exacerbations (odds ratios = 1.99 for every one-point increase on a composite pain scale, P = 0.03) and with lower HRQoL. CONCLUSIONS Pain in adolescents with CF is associated with lower HRQoL and more pulmonary exacerbations. Greater efforts are needed to manage pain in this population and to determine if treatment of pain improves other outcomes.
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Affiliation(s)
- Noah Lechtzin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Sarah Allgood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gina Hong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Riekert
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Psychology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Mogayzel
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Hankinson
- Department of Psychiatry and Psychology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Myron Yaster
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Button BM, Wilson C, Dentice R, Cox NS, Middleton A, Tannenbaum E, Bishop J, Cobb R, Burton K, Wood M, Moran F, Black R, Bowen S, Day R, Depiazzi J, Doiron K, Doumit M, Dwyer T, Elliot A, Fuller L, Hall K, Hutchins M, Kerr M, Lee AL, Mans C, O'Connor L, Steward R, Potter A, Rasekaba T, Scoones R, Tarrant B, Ward N, West S, White D, Wilson L, Wood J, Holland AE. Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline. Respirology 2016; 21:656-67. [PMID: 27086904 PMCID: PMC4840479 DOI: 10.1111/resp.12764] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/21/2022]
Abstract
Physiotherapy management is a key element of care for people with cystic fibrosis (CF) throughout the lifespan. Although considerable evidence exists to support physiotherapy management of CF, there is documented variation in practice. The aim of this guideline is to optimize the physiotherapy management of people with CF in Australia and New Zealand. A systematic review of the literature in key areas of physiotherapy practice for CF was undertaken. Recommendations were formulated based on National Health and Medical Research Council (Australia) guidelines and considered the quality, quantity and level of the evidence; the consistency of the body of evidence; the likely clinical impact; and applicability to physiotherapy practice in Australia and New Zealand. A total of 30 recommendations were made for airway clearance therapy, inhalation therapy, exercise assessment and training, musculoskeletal management, management of urinary incontinence, managing the newly diagnosed patient with CF, delivery of non-invasive ventilation, and physiotherapy management before and after lung transplantation. These recommendations can be used to underpin the provision of evidence-based physiotherapy care to people with CF in Australia and New Zealand.
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Affiliation(s)
| | | | | | | | | | | | | | - Robyn Cobb
- Lady Cilento Children's HospitalBrisbane
| | | | | | | | | | | | | | | | | | | | - Tiffany Dwyer
- Royal Prince Alfred HospitalNSW
- University of SydneySydneyNSW
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jamie Wood
- Sir Charles Gairdner Hospital and Institute for Respiratory HealthWestern Australia
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Lee AL, Rawlings S, Bennett KA, Armstrong D. Pain and its clinical associations in individuals with cystic fibrosis: A systematic review. Chron Respir Dis 2016; 13:102-17. [PMID: 26873725 DOI: 10.1177/1479972316631135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain is recognized as a clinical complication in cystic fibrosis (CF), but the prevalence, characteristics and clinical associations of this co-morbidity have not been systematically reviewed. Electronic searches of six databases were performed. For inclusion in phase 1, studies reported a pain prevalence rate in CF and/or its clinical associations. For phase 2, included studies reported the measurement properties of validity, reliability and responsiveness of an instrument assessing pain in CF. Two independent reviewers rated the quality of evidence (phase 1) and the measurement properties using the 4-point COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist (phase 2). Of the 400 studies identified in the literature, 16 met the inclusion criteria for phase 1 and 5 for phase 2. The mean (SD) quality score (of 16) was 11.8 (2.3). The pooled prevalence of pain in adults with CF was 77% (95% confidence interval (CI): 57%-92%) and in children was 42% (95% CI: 0%-91%). Common regions of pain included back, abdomen, chest and limbs. In children and adults, pain was associated with a poorer quality of life (QOL) and significant interference with treatments. Measurement properties of three instruments (Brief Pain Inventory, Multidimensional Pain Inventory, Daily Pain Assessment-CF) were construct validity and criterion-predictive validity, with variable findings based on 'fair' to 'good' quality studies. Pain is a common problem in both children and adults with CF. It has negative clinical associations with QOL and the ability to successfully undertake treatment. Further research exploring the measurement properties of instruments assessing pain is required.
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Affiliation(s)
- Annemarie L Lee
- West Park Healthcare Centre, Toronto, Ontario, Canada Institute for Breathing and Sleep, Victoria, Australia
| | | | | | - David Armstrong
- Monash Health, Victoria, Australia Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Chen E, Killeen KM, Peterson SJ, Saulitis AK, Balk RA. Evaluation of Pain, Dyspnea, and Goals of Care Among Adults With Cystic Fibrosis: A Comprehensive Palliative Care Survey. Am J Hosp Palliat Care 2016; 34:347-352. [PMID: 26843535 DOI: 10.1177/1049909116629135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Palliative care is increasingly important in the care of adults with cystic fibrosis (CF). Symptoms such as pain and dyspnea are prevalent, yet severity may be underestimated. Little information is available to describe patient preferences for end-of-life care (EOLC). The objective of this study was to describe patient perceptions about pain, dyspnea, and advance care planning. METHODS We developed a survey to assess pain, dyspnea, and EOLC in adults with CF. Questions were compiled and adapted from existing tools. The survey was administered to all patients in a single adult CF care center. Descriptive data were compiled as counts (proportions) and median (25th and 75th percentile). Mann Whitney U test was used to determine differences between individuals who experienced pain and dyspnea. A P value of .05 was utilized to determine significance. RESULTS Thirty-seven of 43 surveys were returned. Twenty-four percent reported chronic pain. Patients who reported pain with airway clearance had lower lung function (predicted forced expiratory volume in 1 [FEV1] 42% vs 65%, P < .05) and body mass index (19.6 vs 22.3, P < .05) than patients without pain. Those reporting dyspnea at rest had lower median FEV1 (28% vs 61%, P < .05). Patients with lower lung function are more likely to have considered end-of-life decisions (73% vs 31%, P < .05). CONCLUSION Pain and dyspnea are common among adults with CF. Few had an advance directive in place, but most are open to discussing EOLC issues. Results of this single-center study may not represent the entire population, thus a multicenter investigation should be pursued.
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Affiliation(s)
- Elaine Chen
- 1 Adult Cystic Fibrosis Center, Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn M Killeen
- 1 Adult Cystic Fibrosis Center, Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sarah J Peterson
- 1 Adult Cystic Fibrosis Center, Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Anna K Saulitis
- 1 Adult Cystic Fibrosis Center, Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robert A Balk
- 1 Adult Cystic Fibrosis Center, Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA
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Goggin J, Cohen RI. CF healthcare workers feel unprepared in providing suitable end of life care and desire more education: Results of a nationwide survey. J Cyst Fibros 2016; 15:85-9. [DOI: 10.1016/j.jcf.2015.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022]
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24
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Development and evaluation of a palliative care curriculum for cystic fibrosis healthcare providers. J Cyst Fibros 2016; 15:90-5. [DOI: 10.1016/j.jcf.2015.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
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Shipton EE, Shipton EA. Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States. Pain Ther 2015; 4:67-87. [PMID: 25920326 PMCID: PMC4470966 DOI: 10.1007/s40122-015-0036-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction A number of studies suggest a link between low levels of 25-hydroxy vitamin D and incidence of acute and chronic pain. Clinical studies of vitamin D supplementation in patients with known vitamin D deficiency have shown mixed results in improving pain scores. Methods In this article, vitamin D deficiency risk factors are observed and adequate levels of 25-hydroxy vitamin D defined. Clinical supplementation with vitamin D is explored, including the schedules used in published clinical trials. Evidence of the effectiveness of vitamin D supplementation for the treatment of chronic pain conditions from double-blind randomized controlled trials (RCTs) is examined. Results The scientific evidence for vitamin D as a treatment option for chronic pain is limited due to lack of RCTs. It cannot be stated conclusively that vitamin D deficiency is directly linked to the etiology or maintenance of chronic pain states. Conclusion There remains a growing body of both clinical and laboratory evidence pointing to a potential relationship between low levels of 25-hydroxy vitamin D and a variety of chronic pain states. More focused research involving large RCTs is necessary. Electronic supplementary material The online version of this article (doi:10.1007/s40122-015-0036-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elspeth E Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
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Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities. PAIN RESEARCH AND TREATMENT 2015; 2015:904967. [PMID: 26090221 PMCID: PMC4427945 DOI: 10.1155/2015/904967] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/15/2015] [Indexed: 12/25/2022]
Abstract
The emergence of new data suggests that the benefits of Vitamin D extend beyond healthy bones. This paper looks at Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. The interfaces between pain and Vitamin D and the mechanisms of action of Vitamin D on pain processes are explored. Finally the association between Vitamin D and pain comorbidities such as sleep and depression is investigated. The paper shows that Vitamin D exerts anatomic, hormonal, neurological, and immunological influences on pain manifestation, thereby playing a role in the aetiology and maintenance of chronic pain states and associated comorbidities. More research is necessary to determine whether Vitamin D is useful in the treatment of various pain conditions and whether or not the effect is limited to patients who are deficient in Vitamin D.
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Blackwell LS, Quittner AL. Daily pain in adolescents with CF: Effects on adherence, psychological symptoms, and health-related quality of life. Pediatr Pulmonol 2015; 50:244-251. [PMID: 25187182 DOI: 10.1002/ppul.23091] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a progressive, life-shortening disease currently treated symptomatically. Among the consequences of daily treatments and long-term progression of the disease is significant discomfort and pain. This study measured pain systematically in adolescents with CF using a pain diary, and evaluated its associations with treatment adherence, psychological symptoms, and health-related quality of life (HRQOL). METHODS This study was part of a larger, multi-center study. Ninety-five adolescents with a mean age of 15.8 were enrolled. A total of 413 online pain diaries were completed for 6 days following a routine clinic visit. Diaries measured pain intensity, location, duration, affective ratings, and coping responses. Adherence to pulmonary medications was measured using prescription refill data; other measures included ratings of depression, anxiety and HRQOL. RESULTS Pain was reported by 74.5% of participants, generally in the mild range, averaging 2.1 on a 10-point scale. Daily pain ratings were highly variable both within and between participants. Pain was significantly associated with worse adherence, more psychological distress, and worse HRQOL. CONCLUSIONS Results indicated that pain is a common problem for adolescents with CF and negatively affects their disease management, psychological symptoms and health outcomes. Routine assessment of pain and systematic studies of interventions to treat pain are recommended. Pediatr Pulmonol. 2015; 50:244-251. © 2014 Wiley Periodicals, Inc.
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Michel-Cherqui M, Ley L, Szekely B, Dreyfus JF, Fischler M. Prevalence and characteristics of pain in patients awaiting lung transplantation. J Pain Symptom Manage 2015; 49:548-54. [PMID: 25150816 DOI: 10.1016/j.jpainsymman.2014.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Pain in patients awaiting lung transplantation is not well known. OBJECTIVES This study prospectively investigated prevalence and characteristics of pain in these patients. METHODS Assessment, undertaken at the time of registration, comprised an interview, a physical examination by a pain-qualified anesthesiologist, and a questionnaire completed by the patient and investigator. This questionnaire included evaluation of pain (intensity, location, sensory and affective qualifications, and treatment), detection of neuropathic pain, and assessment of anxiety and depression. A patient was considered "with pain" when at least one of the following criteria was met: 1) positive answer to the question "Do you suffer regularly from pain?" and 2) score greater than 3 on at least one of three numeric pain scales (current, maximal, and average during the last eight days) ranging from 0 (no pain) to 10 (most severe pain imaginable). RESULTS One hundred forty-three patients were enrolled. Prevalence of pain was 59%. Three independent variables were correlated to the magnitude of the average pain score for the preceding eight days: female gender (P = 0.003), cystic fibrosis (P = 0.02), and depression score (P = 0.02). Among the pain patients, 39% took analgesic drugs daily and 36% regularly but less than daily; 2% used opioids. Nineteen percent used nonpharmacological strategies (e.g., hypnosis, relaxation). CONCLUSION This study highlights the prevalence of pain in this population and specific problems associated with pain such as anxiety and depression. Appropriate assessment and treatment of pain should be considered a component of pretransplantation management.
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Affiliation(s)
- Mireille Michel-Cherqui
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; Pain Management Unit, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Léa Ley
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Barbara Szekely
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; Pain Management Unit, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | | | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France; University Versailles Saint-Quentin-en-Yvelines, Versailles, France.
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A Systematic Review of Factors Associated with Health-Related Quality of Life in Adolescents and Adults with Cystic Fibrosis. Ann Am Thorac Soc 2015; 12:420-8. [DOI: 10.1513/annalsats.201408-393oc] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hubert D, Soubeiran L, Gourmelon F, Grenet D, Serreau R, Perrodeau E, Zegarra-Parodi R, Boutron I. Impact of osteopathic treatment on pain in adult patients with cystic fibrosis--a pilot randomized controlled study. PLoS One 2014; 9:e102465. [PMID: 25029347 PMCID: PMC4100932 DOI: 10.1371/journal.pone.0102465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/16/2014] [Indexed: 12/04/2022] Open
Abstract
Background Pain is a common complication in patients with cystic fibrosis (CF) and is associated with shorter survival. We evaluated the impact of osteopathic manipulative treatment (OMT) on pain in adults with CF. Methods A pilot multicenter randomized controlled trial was conducted with three parallel arms: OMT (group A, 16 patients), sham OMT (sham treatment, group B, 8 patients) and no treatment (group C, 8 patients). Medical investigators and patients were double-blind to treatment for groups A and B, who received OMT or sham OMT monthly for 6 months. Pain was rated as a composite of its intensity and duration over the previous month. The evolution of chest/back pain after 6 months was compared between group A and groups B+C combined (control group). The evolution of cervical pain, headache and quality of life (QOL) were similarly evaluated. Results There was no statistically significant difference between the treatment and control groups in the decrease of chest/back pain (difference = −2.20 IC95% [−4.81; 0.42], p = 0.098); also, group A did not differ from group B. However, chest/back pain decreased more in groups A (p = 0.002) and B (p = 0.006) than in group C. Cervical pain, headache and QOL scores did not differ between the treatment and control groups. Conclusion This pilot study demonstrated the feasibility of evaluating the efficacy of OMT to treat the pain of patients with CF. The lack of difference between the group treated with OMT and the control group may be due to the small number of patients included in this trial, which also precludes any definitive conclusion about the greater decrease of pain in patients receiving OMT or sham OMT than in those with no intervention. Trial Registration ClinicalTrials.gov NCT01293019
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Affiliation(s)
- Dominique Hubert
- Adult CF Center and Pulmonology Department, Hôpital Cochin APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Lucile Soubeiran
- Clinical Research Department, Hôpital Cochin APHP, Paris, France
| | | | - Dominique Grenet
- Adult CF Center and Pulmonology Department, Hôpital Foch, Suresnes, France
| | - Raphaël Serreau
- Clinical Research Department, Hôpital Cochin APHP, Paris, France
| | - Elodie Perrodeau
- Clinical Epidemiology Center, Hôpital Hôtel Dieu APHP, Paris, France
| | - Rafael Zegarra-Parodi
- A.T. Still Research Institute, A.T. Still University, Kirksville, Missouri, United States of America
| | - Isabelle Boutron
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Clinical Epidemiology Center, Hôpital Hôtel Dieu APHP, Paris, France
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Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 13 January 2014.Additional searches of PubMed were performed on 13 January 2014. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Nine trials were identified and seven (with a total of 237 adult participants) were included.Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed to determine effects on fracture rate and survival.
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Affiliation(s)
- Louise S Conwell
- Lady Cilento Children's HospitalEndocrinology and DiabetesStanley StSouth BrisbaneBrisbaneQueenslandAustralia4101
- University of QueenslandSchool of Medicine and Queensland Children's Medical Research Institute300 Herston RoadHerstonQueenslandAustralia4006
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
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Light exposure and depression in hospitalized adult patients with cystic fibrosis. J Affect Disord 2013; 150:585-9. [PMID: 23474091 DOI: 10.1016/j.jad.2013.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/02/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Depression is common in CF. Light therapy is used to treat depression, but exposure in hospitalized CF patients has not been studied. To determine the potential for improvement in depressive symptoms in CF patients, we measured light exposure in hospitalized CF patients. METHODS Light exposure was measured during hospitalization for 30 adult CF patients over 1 week. Depressive symptoms and quality of life were assessed simultaneously using the Center for Epidemiologic Studies Depression Scale (CES-D>16 positive for depression) and the CFQ-R. RESULTS 50% of patients were depressed, with a significant increase in length of stay between depressed and non-depressed patients (15.4 vs. 11.7 days, p=0.032). Only 23% of patients had >60 min of light exposure >1000 lx during 1 week, with average light exposure of 62 lx. There was no difference in light exposure between a new hospital room customized for natural light exposure and traditional rooms. Vitamin D was non-significantly decreased in depressed CF patients (25.1 vs. 32.6 ng/ml, p=0.052). LIMITATIONS The study was not blinded, which may affect patient light preferences. The cohort size was limited to a single center. Inclusion bias may be present as patients could refuse enrollment based on the nature of the study. CONCLUSIONS Hospitalized CF adults have a high incidence of depressive symptoms associated with longer hospitalizations. Hospital settings are associated with low light exposure and phototherapy may be an option for rapid treatment of depression in hospitalized CF patients.
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Havermans T, Colpaert K, De Boeck K, Dupont L, Abbott J. Pain in CF: Review of the literature. J Cyst Fibros 2013; 12:423-30. [DOI: 10.1016/j.jcf.2013.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/15/2013] [Accepted: 04/01/2013] [Indexed: 11/17/2022]
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Estrada-Veras J, Groninger H. Palliative care for patients with cystic fibrosis #265. J Palliat Med 2013; 16:446-7. [PMID: 23442038 DOI: 10.1089/jpm.2013.9515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Abstract
As a testimony to advances in patient care, more individuals with cystic fibrosis are surviving into their adult years than ever before. The clinical epidemiology of this complex multi-organ disease is evolving and has changed dramatically over the past two to three decades. This article discusses the emergence of chronic disease-related co-morbidities such as CF-related diabetes, chronic kidney disease, bone disease, arthropathy, and depression. It also provides an overview of the many challenges confronted by adult CF care providers.
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Affiliation(s)
- Bradley S Quon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington Medical Center, 1959 NE Pacific St., Campus Box 356522, Seattle, Washington, USA, 98195
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36
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Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 15 February 2012.Additional searches of PubMed were performed on 14 May 2011. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Nine trials were identified and seven (with a total of 237 adult participants) were included.Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed to determine effects on fracture rate and survival.
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Mascitelli L, Goldstein MR, Grant WB. Hypovitaminosis D and pain in cystic fibrosis. PAIN MEDICINE 2012; 13:735-6. [PMID: 22494426 DOI: 10.1111/j.1526-4637.2012.01372.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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