The Characteristics of Pain in Patients Diagnosed with Depression and Heart Failure

Abstract

Background Heart failure (HF) is a costly and growing health problem that is routinely complicated by chronic pain and depression. The purpose of this paper is to describe the characteristics of pain and pain management in depressed HF patients. Design/Participants In this descriptive cross-sectional study, we analyzed data from 62 participants with depression and Class II–IV HF. Study variables of interest were collected from the Brief Pain Inventory, Beck Depression Inventory, and Rand-36. Results Almost all participants (98%) had some pain in the past month and most had pain in the last 24 hours (66%). The median pain score was 4 (0–10 scale) with the majority reporting moderate to severe pain. The median pain interference score was 4.42 (0–10 scale) with the majority reporting moderate to extreme interference. Medication to treat pain was used by all participants who reported pain with only 5% also using non-pharmacologic treatment. Conclusion The majority of participants reported moderate or severe pain while also having moderate to extreme pain interference. Non- pharmacologic pain treatments were severely underutilized. Women were more likely to have higher levels of pain intensity and more pain interference than men suggesting that, additional screening for the impact of pain is especially important in women. The wide variety of body areas affected along with moderate to high intensity pain and considerable interference scores reported, indicate that pain was ineffectively treated. Non-pharmacologic treatments should be considered to decrease the impact of pain.

Characterizing Pain Leading to Emergency Medical Services Activation in Heart Failure

“…The number of primary complaints of chest pain and other locations of pain was examined. In previous research, chest pain accounted for 13% to 42% of pain symptoms experienced by outpatients with HF 10,17,22 . In the parent study, 65% of patients reported chest pain on index transport, independent of having a primary complaint of pain (22.2%) 28 .…”

“…Binomial logistic regression was used to evaluate variables associated with presenting with a primary complaint of pain. Variables included in the logistic regression analyses were age, self-reported gender (woman, man); self-reported race (White, Black, Other); shortness of breath; number of comorbid conditions; number of medications; history of coronary artery disease, atrial fibrillation, coronary artery bypass graft, or myocardial infarction; and presence of a pacemaker or implantable cardioverter-defibrillator 7,11,13,20,22–28,33–35 . Ethnicity and history of sudden cardiac arrest were excluded from the regression analysis because of small sample sizes (n < 50 per group).…”

“…For the third aim, locations of pain as well as pain severity scores by location were examined among the subset with a primary complaint of pain. Independent samples t tests were used to compare pain scores across 3 defined groups associated with pain: age (<65 and ≥65 years), gender (man, woman), and race (Black, White) 13,22,39 . χ 2 Tests were used to evaluate whether the percentage of primary pain complaint locations significantly differed by gender, age, and race.…”

“…A systematic review of symptom clusters among patients with HF reported frequent co-occurrence of functional decline with emotional distress and cognitive impairment, all of which may influence pain 20 . Authors of other studies have reported a relationship among pain with fatigue, depression, anxiety, and cognitive dysfunction 21,22 . Patients with HF often present with multiple comorbidities including diabetes, hypertension, atrial fibrillation, and obesity, which can increase prevalence of pain 7,23 .…”

Clinical problems of patients with cachexia due to chronic illness: a congress report

“…In a descriptive cross‐sectional study with 62 CHF patients with NYHA class II‐IV, pain was frequently observed. 50 Ninety‐eight per cent of the patients described unspecified pain in the past month, and 66% had pain in the last 24 h. The character of pain in 1886 CHF patients was assessed in another interventional study. Eighty per cent of patients reported at least some chest pain, and the authors concluded that it was unlikely only due to angina pectoris 51 .…”