Chronic pain 1–5 years after heart transplantation—A nationwide cross‐sectional cohort study

Abstract

Aim To provide a multidimensional assessment of self‐reported chronic pain 1–5 years after heart transplantation and its relationship with self‐reported well‐being, fatigue, recovery, self‐efficacy and socio‐economic factors and to explore differences between heart recipients and a cohort of lung recipients. Design This multicentre, cross‐sectional, cohort study is a part of the Swedish national Self‐management after thoracic transplantation study. Methods Six questionnaires were distributed at the heart recipients yearly follow‐up (1–5 years) at three Swedish university hospitals 2014‐2017. Results The study group comprised of 79 heart recipients, 25 women and 54 men with a mean age of 52.68 years. Chronic pain among heart recipients was common and those not in paid employment as well as those with low psychological well‐being and high general fatigue reported significantly more pain. Female heart recipients were more affected by pain. General health and vitality, general fatigue, physical fatigue and reduced activity were related to the pain intensity score. Relevance to clinical practice As it is the duty of the healthcare system to provide adequate pain treatment, screening for pain should be a mandatory part of long‐term follow‐up.

Symptom Occurrence and Distress after Heart Transplantation—A Nationwide Cross-Sectional Cohort Study

“…In contrast to previous research on symptom distress [20] and chronic pain [8], there were hardly any gender differences regarding symptom distress. The significant gender difference pertaining to increased appetite presumably lacks clinical relevance as the median score was 0 in both groups, indicating no problems at all.…”

“…The HTRs most burdened are those younger than 50 years, not working and living alone. This pattern was also seen regarding chronic pain after HTx [8]. Could it be that younger HTRs experience a pressure to return to work as well as having different conditions regarding family life and parental strain, leading to a greater challenge in terms of social adaptation?…”

“…Symptoms such as pain, depression, gastrointestinal symptoms, poor oral health, and sexual dysfunction have been found to affect the QoL of HTRs [6]. Depression among HTRs is common and increases the risk of mortality [7], while chronic pain affects as many as 75% of HTRs [8]. The view that individuals are responsible for their own health gained greater interest in the latter half of the 20th century [9] and has also been adopted within transplant medicine and nursing [10,11].…”

Fatigue after heart transplantation – a possible barrier to self‐efficacy

“…Fatigue among female HTRs has been shown to be associated with physiological and psychological factors [ 15 ]. Women are also more burdened by chronic pain after HTx [ 32 ], thus highlighting the need to specifically focus on female HTRs when supporting symptom management.…”

“…This was somewhat surprising based on our clinical experience where HTRs are often viewed as being in a much better position than LuTRs in terms of survival, complications and the risk of graft rejection. However, previous studies in the SMATT project have revealed a tendency for HTRs to experience more pain than LuTRs [ 32 ] and that LuTRs seem to adapt and manage their symptoms faster than HTRs [ 35 , 36 ]. This highlights the importance of exploring the differences between HTRs and LuTRs to deeper the understanding of the struggles in their respective recovery processes.…”