Pain and quality of life with chronic obstructive pulmonary disease

doi:10.1016/j.hrtlng.2010.10.009

Heart & Lung

Volume 40, Issue 3, May–June 2011, Pages e90-e101

https://doi.org/10.1016/j.hrtlng.2010.10.009 Get rights and content

Abstract

Background

Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD).

Objective

The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL).

Methods

In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry.

Results

Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant.

Conclusion

The experience of pain is related to disease QOL in patients with COPD.

Section snippets

Design

This article is based on data from a cross-sectional study investigating symptoms of depression, anxiety, and fatigue, sleep quality, pain, QOL, and self-efficacy in patients with COPD. One article about the association between breathlessness and various other symptoms has been published from this study.⁴ The patients were registered on an outpatient unit list at a hospital in Norway during the period June 2005 to May 2006. Participants who agreed to participate were asked to answer a

Characteristics of Demographic Variables, Clinical Variables, and QOL Score

The demographic characteristics of the participants are shown in Table 1. The mean age was 64.6 years (SD ± 10.2) (min = 36 years and max = 87 years). Of 154 participants, 51.3% were men and 48.7% were women. Fifty percent of the participants were living alone. As for smoking history, 55.8% were nonsmokers. The mean value of BMI was 26 (SD ± 5.5). Lung function FEV₁ showed a mean value of 1.6 (SD ± .7). For further information, see Table 1.

Location of Pain, Pain Intensity, and Pain Interference

A total of 111 participants (72.1%) shaded the location

Characteristics of Pain

In view of the lack of attention to pain as a symptom for patients with COPD, it was interesting that 72% of the patients marked areas of pain on the body diagram. This is higher than in the prevalence study by Solano et al⁶ (50% reported pain with COPD). Several studies have used the BPI in investigating pain in different comorbidities. Some have also investigated the cutoff points of mild (0-4), moderate (5-6), and severe pain (7-10).29, 39 In the present study, the mean score was 3.7 for

Conclusions

We found that many patients with COPD experience pain, especially in the shoulders, lumbar region, legs, feet, back, and neck. The experience of pain in patients with COPD is related to reduced disease-specific QOL. However, the effect of pain on global QOL is weaker and seems to be entirely mediated by disease-specific QOL. Because of the cross-sectional design applied, this study could not strictly explain any effect of pain or any consequences, such as the causal direction of significant

Acknowledgments

The authors thank the patients for participating in this study.

References (62)

S. Hurd
The impact of COPD on lung health worldwide: epidemiology and incidence
Chest
(2000)
J.P. Solano et al.
A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease
J Pain Symptom Manage
(2006)
V. Lohne et al.
Qualitative study of pain of patients with chronic obstructive pulmonary disease
Heart Lung
(2010)
T. Rustoen et al.
Prevalence and characteristics of chronic pain in the general Norwegian population
Eur J Pain
(2004)
D.D. Sin et al.
The risk of osteoporosis in Caucasian men and women with obstructive airways disease
Am J Med
(2003)
P. Klepstad et al.
The Norwegian Brief Pain Inventory questionnaire: translation and validation in cancer pain patients
J Pain Symptom Manage
(2002)
C.D. Blinderman et al.
Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease
J Pain Symptom Manage
(2009)
T. Rustoen et al.
Pain and quality of life in hospitalized patients with heart failure
J Pain Symptom Manage
(2008)
R.B. Margolis et al.
A rating system for use with patient pain drawings
Pain
(1986)
S.M. Paul et al.
Categorizing the severity of cancer pain: further exploration of the establishment of cutpoints
Pain
(2005)

G.B. Marks et al.

A scale for the measurement of quality of life in adults with asthma

J Clin Epidemiol

(1992)

K. Stavem et al.

Performance of a short lung-specific health status measure in outpatients with chronic obstructive pulmonary disease

Respir Med

(1999)

A.K. Wahl et al.

Living with cystic fibrosis: impact on global quality of life

Heart Lung

(2005)

P.B. O’Sullivan et al.

Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series

Man Ther

(2007)

M.I. Polkey et al.

Attacking the disease spiral in chronic obstructive pulmonary disease

Clin Med

(2006)

I. Tsuritani et al.

Impact of obesity on musculoskeletal pain and difficulty of daily movements in Japanese middle-aged women

Maturitas

(2002)

S. Maggi et al.

Osteoporosis risk in patients with chronic obstructive pulmonary disease: The EOLO Study

J Clin Densitom

(2009)

T. Nishino et al.

Comparison of pain and dyspnea perceptual responses in healthy subjects

Pain

(2010)

Standards for the diagnosis and management of patients with COPD

(2004)

M.C. Kapella et al.

Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease

Nurs Res

(2006)

C.R. Borge et al.

Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease

J Adv Nurs

(2010)

H. Elkington et al.

The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life

Palliat Med

(2005)

A. Ozge et al.

Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia

J Headache Pain

(2006)

N.R. MacIntyre

Muscle dysfunction associated with chronic obstructive pulmonary disease

Respir Care

(2006)

D.M. Mannino et al.

Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD

Eur Respir J

(2008)

E. Crisafulli et al.

Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation

Thorax

(2008)

D.D. Sin et al.

Mortality in COPD: role of comorbidities

Eur Respir J

(2006)

A.J. Hoffman et al.

Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer

Oncol Nurs Forum

(2007)

M. Heo et al.

Obesity and quality of life: mediating effects of pain and comorbidities

Obes Res

(2003)

R.J. Gatchel et al.

The biopsychosocial approach to chronic pain: scientific advances and future directions

Psychol Bull

(2007)

A.L. Moi et al.

Impaired generic health status but perception of good quality of life in survivors of burn injury

J Trauma

(2006)

Cited by (68)

Beyond breathing: Systematic review of global chronic obstructive pulmonary disease guidelines for pain management
2024, Respiratory Medicine
Patients with chronic obstructive pulmonary disease (COPD) experience pain as both symptom and comorbidity. There has been no evaluation of the recommendations for pain management in updated clinical practice guidelines (CPGs).
Update the evidence on pain management, determine alignment of pain management recommendations with best-practice, and advocate for optimal pain management in patients with COPD.
PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, Institute of Medicine, grey literature, national websites, and bibliographies were searched. CPGs available online for stable COPD produced by organizations representing reputable knowledge of COPD management were included. CPGs unavailable online, not translatable into English, or not including techniques within the defined scope were excluded. Researchers performed frequency counts for the verbatim terms “pain,” “physical activity,” “exercise,” “rehabilitation,” “physical therap(ist)/(y), “physiotherap(ist)/(y),” recorded context, and collected recommendations for pain management/treatment when present.
Of 32 CPGs, 24 included “pain” verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs referred to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing.
Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden is necessary. Pain management should include referrals to providers who can maximize benefit of their services.
Non-pharmacological and non-invasive interventions for chronic pain in people with chronic obstructive pulmonary disease: A systematic review without meta-analysis
2023, Respiratory Medicine
Chronic Obstructive Pulmonary Disease (COPD) is complicated by chronic pain. People with COPD report higher pain prevalence than the general population. Despite this, chronic pain management is not reflected in current COPD clinical guidelines and pharmacological treatments are often ineffective. We conducted a systematic review that aimed to establish the efficacy of existing non-pharmacological and non-invasive interventions on pain and identify behaviour change techniques (BCTs) associated with effective pain management.
A systematic review was conducted with reference to Preferred Reporting Items for Systematic Review (PRISMA) [1], Systematic review without Meta analysis (SWIM) standards [2] and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines [3]. We searched 14 electronic databases for controlled trials of non-pharmacological and non-invasive interventions where the outcome measure assessed pain or contained a pain subscale.
Twenty-nine studies were identified involving 3,228 participants. Seven interventions reported a minimally important clinical difference in pain outcomes, although only two of these reached statistical significance (p < 0.05). A third study reported statistically significant outcomes, but this was not clinically significant (p = 0.0273). Issues with intervention reporting prevented identification of active intervention ingredients (i.e., BCTs).
Pain appears to be a meaningful issue for many individuals with COPD. However, intervention heterogeneity and issues with methodological quality limit certainty about the effectiveness of currently available non-pharmacological interventions. An improvement in reporting is required to enable identification of active intervention ingredients associated with effective pain management.
How Should Opioids Be Started and Titrated?
2023, Evidence-Based Practice of Palliative Medicine, Second Edition
Poor pain management remains a major barrier to high-quality care for patients facing serious illness. Palliative care clinicians have the ability to provide safe and effective pain control for the majority of patients through the appropriate dosing and titration of opioids. This chapter aims to outline basic principles of how to assess pain and considerations of which opioid to start and at what dose.
Cross-sectional study of pain-related variables before and during the COVID-19 pandemic in patients with COPD
2022, Pain Management Nursing
The impact of the COVID-19 pandemic influences of COPD patients. The worsening of their health status may contribute to a higher pain prevalence.
The aim of this study was to analyze the pain-related variables before and during the COVID-19 pandemic in patients with chronic obstructive pulmonary disease.
In this cross-sectional case-control study, stable patients with chronic obstructive pulmonary disease without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pronociceptive pain profile (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (perceived health status, anxiety, and depression).
Our results showed that patients with chronic obstructive pulmonary disease during COVID-19 pandemic experienced higher general pain sensitivity and intensity with statistical differences in pain interference (p < .001), being the overall perceived health status lower than before the pandemic (p < .05).
We concluded that patients with chronic obstructive pulmonary disease during the COVID-19 pandemic showed a rise the pronociceptive pain profile accompanied by increased psychological vulnerability.
Changes in and predictors of pain and mortality in patients with chronic obstructive pulmonary disease
2020, Respiratory Medicine
Citation Excerpt :
The relationship between demographic and clinical characteristics and pain in COPD is unclear and has been mainly investigated in cross-sectional studies. While no sex or age differences were found in two studies [11,16], others found a higher prevalence of pain in females [17,18]. Three studies found no relationship between pain and body mass index (BMI) [11,16,18], while one study found significant relationships between BMI, pain intensity, and pain inference with function [19].
This longitudinal study of patients with chronic obstructive pulmonary disease (COPD) aimed to investigate changes in pain characteristics (i.e., occurrence, intensity, and interference) and covariates associated with pain from study enrollment to 12 months, and to investigate if the different pain characteristics were associated with 5-year mortality. In total, 267 patients with COPD completed questionnaires five times over 1 year. The mean age of the patients was 63 years (standard deviation: 9.0), 53% were women, and 46% had very severe COPD. Median number of comorbidities was 2.0 (range: 0–11) and 47% of patients reported back/neck pain. Mixed models and Cox regression models were used for analyses. In total, 60% of the patients reported pain at baseline, and 61% at 12 months. The mixed model analyses revealed that those with better forced expiratory volume in 1 s (% predicted), more comorbidities, only primary school education, and more respiratory symptoms reported significantly higher average pain intensity. Moreover, those with more comorbidities, more respiratory symptoms, and more depression reported higher pain interference with function. At the 5-year follow-up, 64 patients (24%) were deceased, and the cumulative 5-year mortality rate was 22% (95% confidence interval [19–25]). Older age, lower forced expiratory volume in 1 s (% predicted), and higher pain interference at enrollment were all independently and significantly associated with higher 5-year mortality. Our findings show that many patients with COPD have persistent pain, and awareness regarding comorbidities and how pain interferes with their lives is needed.
Living with COPD: Pain is Important Too
2020, Archivos de Bronconeumologia

View all citing articles on Scopus

: CRB was responsible for collecting data, analyzing, and writing the draft of the article. AKW and TB supervised, performed, analyzed, and completed the draft of the article.

: Funding: Lovisenberg Diaconal Hospital.

: Cite this article: Borge, C. R., Wahl, A. K., & Moum, T. (2011, MAY/JUNE). Pain and quality of life with chronic obstructive pulmonary disease. Heart & Lung, 40(3), e90-e101. doi:10.1016/j.hrtlng.2010.10.009.

View full text

Care of Patients with Pulmonary DisordersPain and quality of life with chronic obstructive pulmonary disease

Abstract

Background

Objective

Methods

Results

Conclusion

Section snippets

Design

Characteristics of Demographic Variables, Clinical Variables, and QOL Score

Location of Pain, Pain Intensity, and Pain Interference

Characteristics of Pain

Conclusions

Acknowledgments

Chest

J Pain Symptom Manage

Heart Lung

Eur J Pain

Am J Med

J Pain Symptom Manage

J Pain Symptom Manage

J Pain Symptom Manage

Pain

Pain

J Clin Epidemiol

Respir Med

Heart Lung

Man Ther

Clin Med

Maturitas

J Clin Densitom

Pain

Standards for the diagnosis and management of patients with COPD

Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease

Nurs Res

Association of breathlessness with multiple symptoms in chronic obstructive pulmonary disease

J Adv Nurs

The healthcare needs of chronic obstructive pulmonary disease patients in the last year of life

Palliat Med

Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia

J Headache Pain

Muscle dysfunction associated with chronic obstructive pulmonary disease

Respir Care

Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD

Eur Respir J

Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation

Thorax

Mortality in COPD: role of comorbidities

Eur Respir J

Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer

Oncol Nurs Forum

Obesity and quality of life: mediating effects of pain and comorbidities

Obes Res

The biopsychosocial approach to chronic pain: scientific advances and future directions

Psychol Bull

Impaired generic health status but perception of good quality of life in survivors of burn injury

J Trauma

Care of Patients with Pulmonary Disorders
Pain and quality of life with chronic obstructive pulmonary disease