Pain in patients with COPD: a systematic review and meta-analysis

Abstract

ObjectivesTo systematically investigate the prevalence of pain, factors related with pain and pain management interventions in patients with chronic obstructive pulmonary disease (COPD).DesignSystematic review and meta-analysis.Data sources and study eligibility criteriaPubMed (MEDLINE), EMBASE, CINAHL and PsychINFO from 1966 to December 2013. Studies were included if they presented clinical data on pain or symptom burden in patients with COPD, or pain as a domain of quality of life (QoL). All types of study designs were included.ResultsOf the 1571 articles that were identified, 39 met the inclusion criteria and were included in this review. Fourteen studies focused on pain and symptom burden (including pain) in patients with COPD and 25 studies focused on QoL using a questionnaire that included a separate pain domain. Reported pain prevalence in high-quality studies ranged from 32 to 60%. Included studies report that pain is more prevalent in patients with COPD compared to participants from the general population. Comorbidity, nutritional status, QoL and several symptoms were related to pain. None of the included studies reported a significant relationship between lung function and pain prevalence or severity. However, studies investigating pain in patients with moderate COPD reported higher pain prevalence compared to studies in patients with severe of very severe COPD.ConclusionsAlthough literature on this topic is limited and shows substantial heterogeneity, pain seems to be a significant problem in patients with COPD and is related to several other symptoms, comorbidity and QoL. Data synthesis suggests that pain is more prevalent in patients with moderate COPD compared to patients with severe or very severe COPD. Further research is needed and should focus on determining a more accurate pain prevalence, investigating the relationship between pain prevalence, disease severity and comorbidity and explore implementation and efficacy of pain management interventions in patients with COPD.

Evidence from diverse clinical populations supported clinical validity of PROMIS pain interference and pain behavior

“…In our a priori search for clinical comparisons by which to evaluate the PROMIS-PI and –PB scores, we found it intuitively attractive to compare by COPD severity. However, though pain is prevalent in COPD (estimates range 32% to 60%), [41] it is not used for diagnosing the condition, classifying its severity, or defining an exacerbation. It is possible to have an exacerbation without increase in pain.…”

Depression, anxiety and chronic pain in patients with chronic obstructive pulmonary disease: the influence of breath

“…Patients reported 2.5 times more pain and 3.7 times more interference of pain with daily activities, compared to healthy people [15]. Higher pain intensity in COPD is associated with poorer life quality, poorer sleep quality, less physical activity and an increased pain-related fear of movement [14].…”

“…One of the current hypotheses is the systemic inflammation usually present in these patients, which activates cytokines, may cause chronic and neuropathic pain [15]. Musculoskeletal disorders, inactivity, age-related comorbidities (osteoporosis, osteoarthritis) are also considered possible causes of pain in patient with COPD [15].The literature on the effects of intervention aimed at reducing pain in patients with COPD is lacking [15].…”

A review of general pain measurement tools and instruments for consideration of use in COPD clinical practice

“…It should be noted that some pain measurement tools/instruments were originally developed in specific disease populations, such as the Brief Pain Inventory,25 which was developed for the measurement of pain in cancer patients and has been utilized in COPD studies 4…”