Heart Failure: The Hidden Problem of Pain

Abstract

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67 ± 11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain ≥ 4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P = 0.02), psychological (depression: P = 0.002; anxiety: P = 0.001), social (P < 0.001), spiritual (P = 0.010), and physical (health status: P = 0.001; symptom frequency: P = 0.000; functional status: P = 0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P < 0.001); interference with relations (P < 0.001) and symptom number (P = 0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF.

Palliative Care in Heart Failure

“…During the course of HF, patients typically experience debilitating physical and emotional symptoms, loss of independence, and disruptions to social roles, all of which severely degrade quality of life (QoL) (3,4). Physical symptoms in advanced HF, such as pain, are highly distressing for patients and caregivers, yet remain under-recognized and undertreated (5,6). Patients and their caregivers (7,8) often face decisions about high-risk and complex treatments (e.g., cardiac devices, transplantation) without adequate prognosis communication, decision support, or advance care planning (9,10).…”

Translating and Testing the ENABLE: CHF-PC Concurrent Palliative Care Model for Older Adults with Heart Failure and Their Family Caregivers

“…2,[12][13][14][15] This seems logical, since persons with advanced HF and their families, like patients with cancer, bear the brunt of unaddressed physical pain and emotional suffering, face a number of complex and difficult medical decisions, 2 and weather multiple hospitalizations in their last year of life. 7,9,[16][17][18][19][20][21] Initiation of interdisciplinary palliative care services beginning early in the course of advanced HF has been strongly recommended as a critical strategy in addressing these challenges by professional groups 6,15,19,[25][26][27][28][29] including the AHA 25 and many others. 5,15,22,23 However, few PC models have undergone systematic development and testing to address the individualized needs of patients with advanced HF and their family caregivers, especially for those in community-based rural locations where geographic distances and access to care can present significant challenges.…”

A closer look: Alternative pain management practices by heart failure patients with chronic pain

“…8 Common chronic pain conditions include low back pain, osteoarthritis, headaches, rheumatoid arthritis, fibromyalgia, peripheral diabetic neuropathy, cancer, 1 and irritable bowel syndrome. 9 Common pain sites reported by people with HF include the lower back, 6,7 lower legs, knees, and shoulders. 7 A history of painful conditions, such as chronic low back pain or osteoarthritis, is documented during admission history, but chronic pain and pain self-management strategies are not routinely assessed, documented, and incorporated into hospital care.…”