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      Distinct pain profiles in patients with chronic obstructive pulmonary disease

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          Abstract

          Background

          Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients.

          Objectives

          The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL).

          Patients and methods

          A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity.

          Results

          Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the “high probability of pain” group, while 29% were in the “moderate probability of pain” group. For the worst pain severity, 37% were in the “moderate pain” and 39% were in the “mild pain” groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale.

          Conclusion

          Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.

          Related collections

          Most cited references 62

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          Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.

          This large scale computer-assisted telephone survey was undertaken to explore the prevalence, severity, treatment and impact of chronic pain in 15 European countries and Israel. Screening interviews identified respondents aged 18 years with chronic pain for in-depth interviews. 19% of 46,394 respondents willing to participate (refusal rate 46%) had suffered pain for 6 months, had experienced pain in the last month and several times during the last week. Their pain intensity was 5 on a 10-point Numeric Rating Scale (NRS) (1 = no pain, 10 = worst pain imaginable) during last episode of pain. In-depth interviews with 4839 respondents with chronic pain (about 300 per country) showed: 66% had moderate pain (NRS = 5-7), 34% had severe pain (NRS = 8-10), 46% had constant pain, 54% had intermittent pain. 59% had suffered with pain for two to 15 years, 21% had been diagnosed with depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job and 13% had changed jobs because of their pain. 60% visited their doctor about their pain 2-9 times in the last six months. Only 2% were currently treated by a pain management specialist. One-third of the chronic pain sufferers were currently not being treated. Two-thirds used non-medication treatments, e.g,. massage (30%), physical therapy (21%), acupuncture (13%). Almost half were taking non-prescription analgesics; 'over the counter' (OTC) NSAIDs (55%), paracetamol (43%), weak opioids (13%). Two-thirds were taking prescription medicines: NSAIDs (44%), weak opioids (23%), paracetamol (18%), COX-2 inhibitors (1-36%), and strong opioids (5%). Forty percent had inadequate management of their pain. Interesting differences between countries were observed, possibly reflecting differences in cultural background and local traditions in managing chronic pain. Chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Very few were managed by pain specialists and nearly half received inadequate pain management. Although differences were observed between the 16 countries, we have documented that chronic pain is a major health care problem in Europe that needs to be taken more seriously.
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            Deciding on the Number of Classes in Latent Class Analysis and Growth Mixture Modeling: A Monte Carlo Simulation Study

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              Pain assessment: global use of the Brief Pain Inventory.

              Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2018
                06 March 2018
                : 13
                : 801-811
                Affiliations
                [1 ]Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
                [2 ]Department of Physiological Nursing, University of California, San Francisco, CA, USA
                [3 ]Department of Community Health Systems, University of California, San Francisco, CA, USA
                [4 ]Department of Master and Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
                [5 ]Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
                [6 ]Department of Circulation and Medical Imaging, St Olav’s University Hospital, Trondheim, Norway
                [7 ]Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
                [8 ]Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
                [9 ]Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
                Author notes
                Correspondence: Signe B Bentsen, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 39, 4021 Stavanger, Norway, Tel +47 51 834 112, Email signe.b.bentsen@ 123456uis.no
                Article
                copd-13-801
                10.2147/COPD.S150114
                5846750
                © 2018 Bentsen et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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