School of Nursing, California State University, Long Beach, Long Beach, California 90840-1006, USA.
J Pain Symptom Manage. 2009 Nov;38(5):698-707. doi: 10.1016/j.jpainsymman.2009.04.022. Epub 2009 Sep 3.
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>or=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.
虽然呼吸困难和疲劳是心力衰竭（HF）的标志性症状，但疼痛负担可能被低估了。本研究评估了 HF 患者的疼痛情况，并确定了促成因素。作为一项多中心研究的一部分，96 名患有 HF 的退伍军人（96%为男性，67+/-11 岁）完成了症状、疼痛（简明疼痛量表[BPI]）、功能状态（功能障碍指数）和心理状态（患者健康问卷-2 和广泛性焦虑障碍-2）的测量。BPI 干扰和生活质量终末的单项评估了社会和精神福祉。通过图表审查获得人口统计学和临床变量。相关和线性回归模型评估了与疼痛相关的身体、情感、社会和精神因素。53 名（55.2%）HF 患者报告有疼痛，其中大多数（36 [37.5%]）报告疼痛为中度至重度（疼痛>或=4/10）。疼痛的报告频率高于呼吸困难（67 [71.3%] vs. 58 [61.7%]）。年龄（P=0.02）、心理（抑郁：P=0.002；焦虑：P=0.001）、社会（P<0.001）、精神（P=0.010）和身体（健康状况：P=0.001；症状频率：P=0.000；功能状态：P=0.002）与疼痛严重程度相关。在得出的模型中，疼痛严重程度的 38%差异可以解释（P<0.001）；关系干扰（P<0.001）和症状数量（P=0.007）对疼痛严重程度有贡献。身体、心理、社会和精神领域与疼痛的关联表明，需要多学科干预来解决 HF 中疼痛的复杂性质。
