An exploration of pain experiences and their meaning in people with chronic obstructive pulmonary disease

Pain is a significant problem in stable chronic obstructive pulmonary disease (COPD) and is associated with other symptoms, worse health status and lower functional status. Not much is known about pain in unstable disease. The primary aim of the present study is to investigate prevalence, characteristics and relationships of pain in patients with COPD hospitalized for an acute exacerbation (AECOPD) and indicated for post-acute pulmonary rehabilitation (PR). This cross-sectional observational study included 149 patients (mean age 70.8 (±7.9) years, 49% male, mean forced expiratory volume in one second as percentage of predicted value 35.3 (±12.6)). Pain was assessed using the brief pain inventory. Functional status and health status were measured using the six-minute walking test (6MWT), the Barthel index (BI) and the clinical COPD questionnaire (CCQ), respectively. Pain was prevalent in 39.6% of all patients. Symptom burden was high, especially in patients with pain. Although we found no difference in objective measurements of functional status (6MWT, BI), patients with pain had clinically relevant lower health status (CCQ), attributed to the functional domain. Pain in patients hospitalized for AECOPD and indicated for post-acute PR is a relevant problem and needs more attention. Incorporation of standard pain assessment during exacerbations and post-acute PR is recommended.

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“…6 Recently, Lee et al reported similar results on the negative interaction between several symptoms and pain. 7…”

Section: Introductionmentioning

confidence: 99%

“…Pain in COPD is also associated with diminished physical activity and lower functional exercise capacity, 8,9 often worsened by pain-related fear of movement. 4,7 The relationship between pain, symptoms and physical activity is important, since lifelong adherence to physical activity is essential to improve HRQoL and prognosis in COPD.…”

Section: Introductionmentioning

confidence: 99%

Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

et al. 2018

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“…44 46 47 Psychological reactions to pain (anger, fear, frustration, depression) were also described in our study as well as previous studies as people talked about how pain overwhelmed or frightened them or negatively impacted their mood, leaving them frustrated, aggravated, depressed or hypervigilant. [25][26][27][28] This suggests that people are able to convey how they physically and psychologically react to pain without the need for an independent observer to be present in the moment pain is being experienced.…”

Section: Discussionmentioning

confidence: 99%

“…11 Previous qualitative research in other diagnoses has investigated more deeply how pain is experienced and expressed and how it interferes with one's life. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] One of the problems inherent in how we respond clinically to pain is that when pain is assessed it is often measured, with a focus on pain intensity using quantitative scales. 23 However, there is an indication that patients use different approaches when rating pain intensity on scales such as the Brief Pain Inventory (BPI), which includes considering how pain fluctuates as well as the location and duration of the pain.…”

Section: Introductionmentioning

confidence: 99%

What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres

et al. 2020

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ObjectivesDigital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing studies have specifically reported on the qualitative patient experience of DU pain, and our current patient-reported outcome measure (PROM) does not capture the multifaceted painful experience of SSc-DU. Our aim was to examine the patient experience of SSc-DU pain.DesignFocus groups with people diagnosed with SSc who had experienced DUs were conducted using a topic guide developed by people with SSc, experts in SSc and experienced qualitative researchers. Focus groups were continued until data saturation had been reached. The focus groups were audio recorded, transcribed verbatim, anonymised and analysed using inductive thematic analysis. Our current study is an integration of the data from these focus groups to specifically examine the patient experience of DU pain.SettingThree specialist scleroderma units across the UK (Bath, Manchester and London).ParticipantsFour focus groups were undertaken; 29 adults (20 women, 9 men) with SSc and a spectrum of historical DUs participated. We included participants with a diverse demographic (including ethnic) background and disease-related characteristics.ResultsFive narrative devices were identified, which encompass how people describe the pain from SSc-DUs: ‘Words to express DU-associated pain’, ‘Descriptions of physical and psychological reactions to pain’, ‘Comparisons with other painful events’, ‘Descriptions of factors that exacerbate pain’ and ‘Descriptions of strategies for coping with the pain’.ConclusionThe experience of SSc-DU pain leads to the use of graphic language and rich description by participants in the focus group setting. Existing SSc-DU outcomes do not adequately capture the patient experiences of SSc-DU pain. Our findings further highlight the multifaceted nature of SSc-DUs and will hopefully support the development of a novel PROM to assess the severity and impact of SSc-DUs.

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“…Similar to the stated inability of van Dam van Isselt et al (2014) to identify a single study reporting a specific intervention strategy to manage pain in people with COPD [3], we also failed to identify such studies. However, the rehabilitation community is clearly working towards this through the confirmation of appropriate pain assessment instruments [86] and qualitative explorations of the pain experiences in people with COPD in order to develop a pain management program specific to this population [87,88].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Pain in Clinical Practice Guidelines for Management of COPD: A Case for Including Chronic Pain?

et al. 2019

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Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD.

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An exploration of pain experiences and their meaning in people with chronic obstructive pulmonary disease

Abstract: Patients report difficulty in explaining the persistence of pain. This fosters a need to legitimize their pain, which influences feelings of frustration and self-worth. An understanding of these responses will assist health care professionals in managing on-going pain in those with COPD.

Cited by 13 publications

References 37 publications

Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

Pain in patients with chronic obstructive pulmonary disease indicated for post-acute pulmonary rehabilitation

What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres

Systematic Review of Pain in Clinical Practice Guidelines for Management of COPD: A Case for Including Chronic Pain?

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