Date Published: May 24, 2019
Publisher: Public Library of Science
Author(s): Maxime Maignan, Jean-Marc Chauny, Raoul Daoust, Ludivine Duc, Prudence Mabiala-Makele, Roselyne Collomb-Muret, Matthieu Roustit, Caroline Maindet, Jean-Louis Pépin, Damien Viglino, Shane Patman.
Pain, a symptom often present in patients with Chronic Obstructive Pulmonary Disease (COPD), alters quality of life. COPD exacerbation augments several mechanisms that may cause pain (dyspnea, hyperinflation and inflammation) and therefore we hypothesized that pain might be increased during exacerbation.
A prospective cohort study was conducted in patients admitted for acute exacerbations of COPD (AECOPD) in two emergency departments in France and Canada. Patients with cancer-related pain or recent trauma were not included. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI) scale were used to evaluate pain intensity and location. Patients also completed the Borg Dyspnea Scale and Hospital Anxiety and Depression Scale. The questionnaires were completed again during an outpatient assessment in the stable phase. The primary outcome was difference in pain intensity (SF-MPQ) between the exacerbation and stable phases.
Fifty patients were included. During exacerbation, 46 patients (92%) reported pain compared to 29 (58%) in the stable phase (p<0.001). Pain intensity was higher during exacerbation (SF-MPQ 29.7 [13.6–38.2] vs. 1.4 [0.0–11.2]; p<0.001). Pain was predominantly located in the chest during exacerbation and in the limbs during the stable phase. Pain intensity during exacerbation correlated with anxiety score. The frequency and intensity of pain were higher during AECOPD, with a specific distribution. Pain should therefore be routinely assessed and treated in patients with AECOPD.
The current aim of treatment for exacerbations of chronic obstructive pulmonary disease (COPD) is to relieve the respiratory symptoms, improve respiratory function and normalize blood gases . COPD is, however, a multi-dimensional disorder and the treatment of comorbidities and extra-pulmonary symptoms is emerging as equally important during acute exacerbations (AECOPD) . Care-strategies now incorporate cardiovascular comorbidities, muscle dysfunction and nutritional aspects, as well as the management of anxiety and pain [2,3].
Between April 2016, and January 2018, 248 patients admitted for an AECOPD were screened and 50 were included. The study profile is shown in Fig 1 and the characteristics of the participants at inclusion are presented in Tables 1 and 2. The median delay between admission and the follow-up visit was 36 days [31–45].
This study is the first to report high levels and prevalence of pain in AECOPD. Almost all participants reported pain during exacerbation and just over half during the stable phase. Pain intensity was also much higher during exacerbation compared with the stable phase. Pain was predominantly located in the chest during exacerbation and pain location shifted in the stable phase.
This study found a higher prevalence and intensity of pain and a difference in pain locations during COPD exacerbations compared to the stable phase. During exacerbation, pain ratings were correlated with both dyspnea and anxiety. Based on the results of the present study, we suggest the assessment and treatment of pain should be integrated into multimodal care approaches for AECOPD in order to improve patient centered outcomes. New studies are also required to evaluate pain management during AECOPD and the consequences of pain on patient outcomes.