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

Abstract

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.

<p>Pain Prevalence, Localization, and Intensity in Adults with and without COPD: Results from the Danish Health and Morbidity Survey (a Self-reported Survey)</p>

“…8 The causality of the high pain prevalence and persistent pain in people with COPD is complex and poorly understood. 8,9 Persistent pain is a clinical issue with significant clinical implications, which adversely impacts QOL, mood, breathlessness, and participation in activities of daily living. 8 A sedentary lifestyle as a result of, eg dyspnea and fear of activity-induced discomfort may aggravate common age-related comorbidities, among them osteoarthritis, low back pain and osteoporosis of which pain is a frequently reported manifestation.…”

“…8,9 Persistent pain is a clinical issue with significant clinical implications, which adversely impacts QOL, mood, breathlessness, and participation in activities of daily living. 8 A sedentary lifestyle as a result of, eg dyspnea and fear of activity-induced discomfort may aggravate common age-related comorbidities, among them osteoarthritis, low back pain and osteoporosis of which pain is a frequently reported manifestation. 6,10,11 Other factors related to the manifestations of COPD may also contribute to pain in people with COPD.…”

“…Pain prevalence in people with COPD was recently published in a systematic review, and ranged from 21–82% in the included studies with a mean pooled estimate of 66%. 8 The causality of the high pain prevalence and persistent pain in people with COPD is complex and poorly understood. 8 , 9 Persistent pain is a clinical issue with significant clinical implications, which adversely impacts QOL, mood, breathlessness, and participation in activities of daily living.…”

“… 8 The causality of the high pain prevalence and persistent pain in people with COPD is complex and poorly understood. 8 , 9 Persistent pain is a clinical issue with significant clinical implications, which adversely impacts QOL, mood, breathlessness, and participation in activities of daily living. 8 …”

“… 8 , 9 Persistent pain is a clinical issue with significant clinical implications, which adversely impacts QOL, mood, breathlessness, and participation in activities of daily living. 8 …”