Heart Failure: The Hidden Problem of Pain

Goebel, Joy R.; Doering, Lynn V.; Shugarman, Lisa R.; Asch, Steve M.; Sherbourne, Cathy D.; Lanto, Andy B.; Evangelista, Lorraine S.; Nyamathi, Adeline M.; Maliski, Sally L.; Lorenz, Karl A.

doi:10.1016/j.jpainsymman.2009.04.022

« Previous Next »Journal of Pain and Symptom Management
Volume 38, Issue 5 , Pages 698-707, November 2009

Heart Failure: The Hidden Problem of Pain

Joy R. Goebel, RN, PhD
- School of Nursing, California State University, Long Beach, Long Beach, California, USA
- Address correspondence to: Joy R. Goebel, RN, PhD, School of Nursing, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840-1006, USA.
Lynn V. Doering, RN, DNSc
- School of Nursing, University of California, Los Angeles, Los Angeles, California, USA
Lisa R. Shugarman, PhD
- RAND Corporation, Santa Monica, California, USA
Steve M. Asch, MD, MPH
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
Cathy D. Sherbourne, PhD
- RAND Corporation, Santa Monica, California, USA
Andy B. Lanto, MA
- Veterans Integrated Palliative Program, Department of Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
Lorraine S. Evangelista, RN, PhD
- School of Nursing, University of California, Los Angeles, Los Angeles, California, USA
Adeline M. Nyamathi, RN, PhD
- School of Nursing, University of California, Los Angeles, Los Angeles, California, USA
Sally L. Maliski, RN, PhD
- School of Nursing, University of California, Los Angeles, Los Angeles, California, USA
Karl A. Lorenz, MD, MSHS
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA

Accepted 9 April 2009. published online 04 September 2009.

Abstract

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67±11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain≥4/10). The presence of pain was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P=0.02), psychological (depression: P=0.002; anxiety: P=0.001), social (P<0.001), spiritual (P=0.010), and physical (health status: P=0.001; symptom frequency: P=0.000; functional status: P=0.002) well-being were correlated with pain severity. In the resulting model, 38% of the variance in pain severity was explained (P<0.001); interference with relations (P<0.001) and symptom number (P=0.007) contributed to pain severity. The association of physical, psychological, social, and spiritual domains with pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HF.