Advertisement

Comorbidities That Cause Pain and the Contributors to Pain in Individuals With Chronic Obstructive Pulmonary Disease

Published:November 17, 2016DOI:https://doi.org/10.1016/j.apmr.2016.10.016

      Abstract

      Objective

      To determine comorbidities that cause pain and the potential contributors to pain in individuals with chronic obstructive pulmonary disease (COPD).

      Design

      Prospective cross-sectional survey study.

      Setting

      Pulmonary rehabilitation programs of 6 centers.

      Participants

      A convenience sample of individuals with COPD (N=137) who attended pulmonary rehabilitation programs. In total, 100 (73%) returned the survey packages. Of those responders, 96 participants (70%) were included in the analyses.

      Interventions

      Not applicable.

      Main Outcome Measures

      Pain was measured using the Brief Pain Inventory. The questionnaire used to obtain information about health conditions that might contribute to pain and a medication record asked, in lay terms, about comorbidities that cause pain. The health conditions that cause pain were then validated by health professionals. Demographics, fatigue, dyspnea, quality of life, and self-efficacy were also measured using questionnaires.

      Results

      Pain was reported in 71% (68/96) of participants. Low back pain was the most common location (41%). Arthritis (75%), back problems (47%), and muscle cramps (46%) were the most common comorbidities that caused pain. Lower self-efficacy, and renting rather than home ownership increased the likelihood of pain (P<.05). Pain severity and Brief Fatigue Inventory scores contributed to pain interference scores (P<.05).

      Conclusions

      Pain was highly prevalent in pulmonary rehabilitation program participants with COPD. The most common causes of pain were musculoskeletal conditions. Pain severity and higher levels of fatigue contributed to how pain interfered with daily aspects of living. The assessment and management of pain need to be addressed within the overall care of individuals with COPD.

      Keywords

      List of abbreviations:

      BFI (Brief Fatigue Inventory), BPI (Brief Pain Inventory), CCQ (Clinical COPD Questionnaire), COPD (chronic obstructive pulmonary disease), CVD (cardiovascular disease), DI (Dyspnea Inventory), GSE (General Self-Efficacy Scale), QOL (quality of life)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • O'Donnell D.E.
        • Hernandez P.
        • Kaplan A.
        • et al.
        Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease–2008 update–highlights for primary care.
        Can Respir J. 2008; 15: 1A-8A
        • Sin D.D.
        • Anthonisen N.R.
        • Soriano J.B.
        • Agusti A.G.
        Mortality in COPD: role of comorbidities.
        Eur Respir J. 2006; 28: 1245-1257
        • Crisafulli E.
        • Costi S.
        • Luppi F.
        • et al.
        Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation.
        Thorax. 2008; 63: 487-492
        • HajGhanbari B.
        • Yamabayashi C.
        • Garland S.J.
        • Road J.D.
        • Reid W.D.
        The relationship between pain and comorbid health conditions in people with chronic obstructive pulmonary disease.
        Cardiopulm Phys Ther J. 2014; 25: 29-35
        • Yawn B.
        • Kaplan A.
        Co-morbidities in people with COPD: a result of multiple diseases, or multiple manifestations of smoking and reactive inflammation.
        Prim Care Respir J. 2008; 17: 199-205
        • Burgel P.-R.
        • Escamilla R.
        • Perez T.
        • et al.
        Impact of comorbidities on COPD-specific health-related quality of life.
        Respir Med. 2013; 107: 233-241
        • Bentsen S.B.
        • Miaskowski C.
        • Rustøen T.
        Demographic and clinical characteristics associated with quality of life in patients with chronic obstructive pulmonary disease.
        Qual Life Res. 2014; 23: 991-998
        • Borge C.R.
        • Wahl A.K.
        • Moum T.
        Pain and quality of life with chronic obstructive pulmonary disease.
        Heart Lung. 2011; 40: e90-e101
        • HajGhanbari B.
        • Holsti L.
        • Road J.D.
        • Reid W.D.
        Pain in people with chronic obstructive pulmonary disease (COPD).
        Respir Med. 2012; 106: 998-1005
        • HajGhanbari B.
        • Garland S.J.
        • Road J.D.
        • Reid W.D.
        Pain and physical performance in people with COPD.
        Respir Med. 2013; 107: 1692-1699
        • Bentsen S.B.
        • Rustoen T.
        • Miaskowski C.
        Differences in subjective and objective respiratory parameters in patients with chronic obstructive pulmonary disease with and without pain.
        Int J Chron Obstruct Pulmon Dis. 2012; 7: 137-143
        • van Dam van Isselt E.F.
        • Groenewegen-Sipkema K.H.
        • Spruit-van Eijk M.
        • et al.
        Pain in patients with COPD: a systematic review and meta-analysis.
        BMJ Open. 2014; 4: e005898
        • Elliott A.M.
        • Smith B.H.
        • Penny K.I.
        • Smith W.C.
        • Chambers W.A.
        The epidemiology of chronic pain in the community.
        Lancet. 1999; 354: 1248-1252
        • Nayak S.
        • Shiflett S.C.
        • Eshun S.
        • Levine F.M.
        Culture and gender effects in pain beliefs and the prediction of pain tolerance.
        Cross Cult Res. 2000; 34: 135-151
        • Turk D.C.
        • Okifuji A.
        Psychological factors in chronic pain: evolution and revolution.
        J Consult Clin Psychol. 2002; 70: 678-690
        • Cleeland C.
        • Ryan K.
        Pain assessment: global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Tanaka K.
        • Akechi T.
        • Okuyama T.
        • Nishiwaki Y.
        • Uchitomi Y.
        Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer.
        J Pain Symptom Manage. 2002; 23: 417-423
        • Van der Molen T.
        • Willemse B.W.
        • Schokker S.
        • Ten Hacken N.H.
        • Postma D.S.
        • Juniper E.F.
        Development, validity and responsiveness of the Clinical COPD Questionnaire.
        Health Qual Life Outcomes. 2003; 1: 13
        • Schwarzer R.
        • Jerusalem M.
        Generalized Self-Efficacy Scale.
        in: Weinman J. Wright S. Johnston M. Measures in health psychology: a user's portfolio. Causal and control beliefs. NFER-Nelson, Windsor1995: 35-37
        • Charlson M.E.
        • Charlson R.E.
        • Peterson J.C.
        • Marinopoulos S.S.
        • Briggs W.M.
        • Hollenberg J.P.
        The Charlson Comorbidity Index is adapted to predict costs of chronic disease in primary care patients.
        J Clin Epidemiol. 2008; 61: 1234-1240
        • Johannes C.B.
        • Le T.K.
        • Zhou X.
        • Johnston J.A.
        • Dworkin R.H.
        The prevalence of chronic pain in United States adults: results of an Internet-based survey.
        J Pain. 2010; 11: 1230-1239
        • Chen Y.-W.
        • Coxson H.O.
        • Reid W.D.
        Reliability and validity of the Brief Fatigue Inventory and Dyspnea Inventory in people with chronic obstructive pulmonary disease.
        J Pain Symptom Manage. 2016; 52: 298-304
        • Bandura A.
        Self-efficacy: toward a unifying theory of behavioral change.
        Psychol Rev. 1977; 84: 191-215
        • Faul F.
        • Erdfelder E.
        • Lang A.-G.
        • Buchner A.
        G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Rustøen T.
        • Wahl A.K.
        • Hanestad B.R.
        • Lerdal A.
        • Paul S.
        • Miaskowski C.
        Prevalence and characteristics of chronic pain in the general Norwegian population.
        Eur J Pain. 2004; 8: 555-565
        • Bentsen S.B.
        • Rustoen T.
        • Miaskowski C.
        Prevalence and characteristics of pain in patients with chronic obstructive pulmonary disease compared to the Norwegian general population.
        J Pain. 2011; 12: 539-545
        • Toblin R.L.
        • Mack K.A.
        • Perveen G.
        • Paulozzi L.J.
        A population-based survey of chronic pain and its treatment with prescription drugs.
        Pain. 2011; 152: 1249-1255
        • Roberts M.H.
        • Mapel D.W.
        • Hartry A.
        • Von Worley A.
        • Thomson H.
        Chronic pain and pain medication use in chronic obstructive pulmonary disease. A cross-sectional study.
        Ann Am Thorac Soc. 2013; 10: 290-298
        • Heneghan N.
        • Adab P.
        • Jackman S.
        • Balanos G.
        Musculoskeletal dysfunction in chronic obstructive pulmonary disease (COPD): an observational study.
        Int J Ther Rehabil. 2015; 22: 119-128
        • Johansson E.-L.
        • Ternesten-Hasséus E.
        • Olsén M.F.
        • Millqvist E.
        Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD.
        Respir Med. 2012; 106: 1006-1013
        • Lee A.L.
        • Harrison S.L.
        • Goldstein R.S.
        • Brooks D.
        Pain and its clinical associations in individuals with COPD: a systematic review.
        Chest. 2015; 147: 1246-1258
        • Janssen D.A.
        • Wouters E.F.
        • Parra Y.L.
        • Stakenborg K.
        • Franssen F.M.
        Prevalence of thoracic pain in patients with chronic obstructive pulmonary disease and relationship with patient characteristics: a cross-sectional observational study.
        BMC Pulm Med. 2016; 16: 1-8
        • Blyth F.M.
        • March L.M.
        • Cousins M.J.
        Chronic pain-related disability and use of analgesia and health services in a Sydney community.
        Med J Aust. 2003; 179: 84-87
        • Bolton C.E.
        • Ionescu A.A.
        • Shiels K.M.
        • et al.
        Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease.
        Am J Respir Crit Care Med. 2004; 170: 1286-1293
        • Kanis J.A.
        • Johnell O.
        • Odén A.
        • et al.
        Smoking and fracture risk: a meta-analysis.
        Osteoporos Int. 2005; 16: 155-162
        • Chilibeck P.D.
        • Sale D.G.
        • Webber C.E.
        Exercise and bone mineral density.
        Sports Med. 1995; 19: 103-122
        • McEvoy C.E.
        • Niewoehner D.E.
        Adverse effects of corticosteroid therapy for COPD: a critical review.
        Chest. 1997; 111: 732-743
        • Dimai H.P.
        • Domej W.
        • Leb G.
        • Lau K.H.
        Bone loss in patients with untreated chronic obstructive pulmonary disease is mediated by an increase in bone resorption associated with hypercapnia.
        J Bone Miner Res. 2001; 16: 2132-2141
        • Genant H.K.
        • Li J.
        • Wu C.Y.
        • Shepherd J.A.
        Vertebral fractures in osteoporosis: a new method for clinical assessment.
        J Clin Densitom. 2000; 3: 281-290
        • Felson D.T.
        • Lawrence R.C.
        • Dieppe P.A.
        • et al.
        Osteoarthritis: new insights. Part 1: the disease and its risk factors.
        Ann Intern Med. 2000; 133: 635-646
        • Mannino D.M.
        • Thorn D.
        • Swensen A.
        • Holguin F.
        Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.
        Eur Respir J. 2008; 32: 962-969
        • Gale N.S.
        • Duckers J.M.
        • Enright S.
        • Cockcroft J.R.
        • Shale D.J.
        • Bolton C.E.
        Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?.
        BMC Pulm Med. 2011; 11: 20
        • Solano J.P.
        • Gomes B.
        • Higginson I.J.
        A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease.
        J Pain Symptom Manage. 2006; 31: 58-69
        • Litt M.D.
        Self-efficacy and perceived control: cognitive mediators of pain tolerance.
        J Pers Soc Psychol. 1988; 54: 149-160
        • Miller C.
        • Newton S.E.
        Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization.
        Pain Manag Nurs. 2006; 7: 148-152
        • Macfarlane G.J.
        • Norrie G.
        • Atherton K.
        • Power C.
        • Jones G.T.
        The influence of socioeconomic status on the reporting of regional and widespread musculoskeletal pain: results from the 1958 British Birth Cohort Study.
        Ann Rheum Dis. 2009; 68: 1591-1595
        • Boardman J.D.
        • Robert S.A.
        Neighborhood socioeconomic status and perceptions of self-efficacy.
        Sociol Perspect. 2000; 43: 117-136
        • Pajares F.
        • Hartley J.
        • Valiante G.
        Response format in writing self-efficacy assessment: greater discrimination increases prediction.
        Meas Eval Couns Dev. 2001; 33: 214-221
        • Beck S.L.
        • Dudley W.N.
        • Barsevick A.
        Pain, sleep disturbance, and fatigue in patients with cancer: using a mediation model to test a symptom cluster.
        Oncol Nurs Forum. 2005; 32: 542
        • Pollard L.
        • Choy E.
        • Gonzalez J.
        • Khoshaba B.
        • Scott D.
        Fatigue in rheumatoid arthritis reflects pain, not disease activity.
        Rheumatology (Oxford). 2006; 45: 885-889
        • Waschki B.
        • Kirsten A.
        • Holz O.
        • et al.
        Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study.
        Chest. 2011; 140: 331-342
        • Qaseem A.
        • Wilt T.J.
        • Weinberger S.E.
        • et al.
        Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society.
        Ann Intern Med. 2011; 155: 179-191