Qualitative study of pain of patients with chronic obstructive pulmonary disease

doi:10.1016/j.hrtlng.2009.08.002

Heart & Lung

Volume 39, Issue 3, May–June 2010, Pages 226-234

https://doi.org/10.1016/j.hrtlng.2009.08.002 Get rights and content

Objective

This study evaluated the pain experiences of patients with chronic obstructive pulmonary disease (COPD).

Sample

We studied 16 patients with severe COPD.

Design

A semistructured interview was performed to obtain information on patients' experiences with pain and the impact of pain on quality of life (QOL). Data were analyzed using the methodology of Kvale.

Results

Three main themes emerged: incomprehensible and unbearable pain; locked in my body and shut out from the world; and the vicious COPD circle. Patients reported moderate to severe pain located primarily in the shoulders, neck, upper arms, and chest. Patients reported a number of severe symptoms occurring simultaneously, and negatively affecting each other. Vicious circles of pain, breathlessness, sleep disturbance, and anxiety were described as exerting negative effects on patients' QOL.

Conclusion

Unrelieved pain appears to be a significant problem in patients with COPD. Research is warranted to determine if pain is clustered with other symptoms, and how these symptoms affect the clinical management of COPD.

Section snippets

Design

Because so little research is available on pain in patients with COPD, a qualitative design with interviews was used to fulfill our study aims. To supplement the qualitative data, a valid and reliable measure of pain (ie, the Brief Pain Inventory¹³) was used to collect data about pain intensity, pain location, and pain interference.

Recruitment procedures

Patients were recruited if they met the following criteria: a diagnosis of grade III or IV COPD,¹⁴ age >40 years, experiencing pain, competent to be interviewed in a

Demographic and clinical characteristics of patients

As shown in Table 2, 75% (n = 13) of the patients were female, with a mean age of 57.9 years (SD, 4.1). The majority were living with a spouse or children (n = 10), had a secondary or college education (n = 13), and were retired (n = 14). All of the patients had severe COPD, and 5 were awaiting a lung transplant (Table 2).

As shown in Table 3, the present, average, and worst pain-intensity scores ranged from 3.4 to 5.4. Of note, 38% of patients reported an average pain score of >6. In terms of

Discussion

To our knowledge, this study is the first to explore and describe the experiences of pain in patients with COPD. Fewer than half (38%) of patients admitted to the hospital for management of their COPD reported pain. However, approximately three quarters of those who had pain reported that their worst pain intensity scores were in the moderate to severe range (≥4 on an 11-point scale).¹⁹ Given that the majority of these patients reported pain in the chest and neck suggests that the etiology may

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Cited by (64)

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.
Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study
2023, Journal of Integrative Medicine
This study aimed to investigate the feasibility of implementing a manual therapy technique (muscle energy technique, MET) protocol in a hospital pulmonary rehabilitation (PR) program for patients with moderate to severe chronic obstructive pulmonary disease (COPD).
Please cite this article as: Baxter DA, Coyle ME, Hill CJ, Worsnop C, Shergis JL. Muscle energy technique for chronic obstructive pulmonary disease: A feasibility study. J Integr Med. 2023; 21(3): 245–253.
Participants aged 40 years and over, with moderate to severe COPD, were recruited into this 12-week study. The primary outcome measures were feasibility (acceptability of the intervention and attendance/adherence to the trial) and safety (adverse events, AEs). All participants received the MET and PR therapies. Participants and assessors were unblinded. Semi-standardized MET was delivered on 6 occasions (a maximum of once per week) at the hospital directly before a PR session. Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks. Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.
Thirty-three participants were enrolled, with a median age of 74 years (range 45–89 years). The median number of MET sessions that participants attended was 5 (range 0–6) out of a possible 6 sessions (83% attendance). At follow-up, participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing. There were no major AEs related to the intervention, with the majority of AEs classified as expected events related to COPD exacerbations.
It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting. Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.
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.
Symptom burden in patients with chronic obstructive pulmonary disease
2021, Applied Nursing Research
Citation Excerpt :
Much of this research has been qualitative, aimed at exploring their ‘lived experiences’ including symptom experiences. Most research on symptom experience has addressed breathlessness (Avsar & Kasilkci, 2011; Barnett, 2005; EK & Ternested, 2008; Gullick & Stainton, 2008; Prabbhu, Kamath, Shivananda Pai, & Sanatombi Devi, 2018; Simonÿ, Andersen, Bodtger, & Birkelund, 2019), with fewer studies addressing other symptoms such as pain (Hasson et al., 2008; Lohne et al., 2010), fatigue, cough (Avsar & Kasilkci, 2011; EK, Sahlberg, Blome, Andershed, & Ternestedt, 2011), anorexia, weight loss, and sleep disturbance (Hasson et al., 2008; Seamark, Blake, & Seamark, 2004). Psychological symptoms described in previous research on individuals' experiences of living with COPD include fear, sadness, irritability, anxiety, depression (Avsar & Kasilkci, 2011; Gullick & Stainton, 2008; Hasson et al., 2008; Prabbhu et al., 2018), frustration, anger (Barnett, 2005), distress and panic (Gysels & Higginson, 2011; Lohne et al., 2010).
There is now a growing body of evidence to suggest that patients with chronic disease experience their symptoms as a burden. Although symptoms are a principal focus for diagnosis and treatment of chronic obstructive pulmonary disease (COPD), there has been little research to date on symptom burden with reference to frequency, severity, and distress of symptoms.
A descriptive, cross-sectional survey design was used. Symptom burden was measured using the Memorial Symptom Assessment Scale (MSAS). A sample of 214 patients with COPD, recruited from one of the major teaching hospitals in Ireland.
Patients experienced a median of 13 symptoms. Patients with ‘very severe’ COPD experienced the greatest number, with a median of 15 symptoms, followed by those with ‘severe’ COPD, with a median of 14 symptoms. Patients with ‘mild’ and ‘moderate’ COPD reported a median of 10 symptoms each. The most burdensome symptoms were shortness of breath, lack of energy, difficulty sleeping, worrying, dry mouth, feeling nervous, and feeling irritable. Total symptom burden was found to be low. Patients with ‘very severe’ COPD had the greatest symptom burden, followed by those with ‘severe’, ‘moderate’, and ‘mild’ COPD. Symptom burden was higher for psychological symptoms, with a mean score of 1.60 compared to the physical symptoms (mean = 0.87).
Patients with COPD experience a remarkably high number of symptoms, and significant symptom burden of both physical and psychological symptoms. There is a need for early assessment and management of both physical and psychological symptoms in all patients with COPD.
Changes in and predictors of pain and mortality in patients with chronic obstructive pulmonary disease
2020, Respiratory Medicine
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.
Increased pain sensitivity, postural abnormalities, and functional balance impairment in obstructive lung disease compared to healthy subjects
2019, Heart and Lung
Citation Excerpt :
In addition, recent reports have identified pain as a comorbidity.2,3 Patients with COPD have highly variable prevalence and severity of pain symptoms.4–6 In a systematic review of 9 studies, the prevalence of pain in moderate to very severe COPD was 66%.7
Recent reports have identified pain as a comorbidity in obstructive lung diseases, but data regarding pain in certain obstructive lung diseases such as COPD and bronchiectasis vs. healthy controls and differences in pain between these chronic lung diseases are limited.
The primary aim of this study was to compare pain sensitivity, postural abnormalities, and functional balance in patients with COPD/bronchiectasis vs. healthy controls. The secondary aim was to evaluate differences in these parameters between two different lung diseases (COPD and bronchiectasis).
Twenty-nine patients with moderate to severe COPD/bronchiectasis and 31 healthy age/gender-matched individuals participated in the study. Pain sensitivity was assessed with an algometer. Postural abnormalities were analyzed from the lateral and posterior view. Functional balance was evaluated using the Timed Up and Go test (TUG).
Significantly more patients reported pain compared to the healthy controls (89.7% vs. 19.4%, respectively) (p < 0.05). The pressure pain thresholds of the trapezius and deltoid muscles and pain tolerance of the pectoralis major muscle were significantly lower in patients compared to healthy subjects (p < 0.05). Total and posterior posture scores and TUG time were significantly higher in patients compared to the control group (p < 0.05).
This study showed that pain perception, severity, and sensitivity are increased in patients with COPD or bronchiectasis compared to the healthy population. These patients also have more severe postural abnormalities and functional balance impairment than the healthy population.

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Issues in Pulmonary NursingQualitative study of pain of patients with chronic obstructive pulmonary disease

Objective

Sample

Design

Results

Conclusion

Section snippets

Design

Recruitment procedures

Demographic and clinical characteristics of patients

Discussion

Chest

J Clin Epidemiol

Respir Med

Chest

Pain

Incidence of GOLD-defined chronic obstructive pulmonary disease in a general adult population

Int J Tuberc Lung Dis

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36

Qual Life Res

Determinants of health-related quality of life in patients with chronic obstructive pulmonary disease

Thorax

Palliative care in chronic obstructive airways disease: a needs assessment

Palliat Med

A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer

Palliat Med

Palliative care in chronic obstructive pulmonary disease: a review for clinicians

J R Soc Med

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

Palliat Med

Living and dying with chronic obstructive pulmonary disease

J Am Geriatr Soc

Issues in Pulmonary Nursing
Qualitative study of pain of patients with chronic obstructive pulmonary disease