Clark Nathan, Fan Vincent S, Slatore Christopher G, Locke Emily, Whitson Heather E, Nici Linda, Thielke Stephen M
1 University of Washington.
Ann Am Thorac Soc. 2014 Jul;11(6):890-7. doi: 10.1513/AnnalsATS.201310-369OC.
Experimental and neuroimaging studies have suggested strong associations between dyspnea and pain. The co-occurrence of these symptoms has not been examined in community samples.
We sought to ascertain the co-occurrence of pain and dyspnea by self-report in a large cohort of Medicare recipients.
We analyzed data from 266,000 Medicare Managed Care recipients surveyed in 2010 and 2012. Dyspnea was defined by aggregating three questions about shortness of breath (at rest, while walking one block, and while climbing stairs). Pain was measured by four questions about pain interference, chest pain, back pain, and arthritis pain. All measures were dichotomized as high or low/none. We calculated the co-occurrence of pain and dyspnea at baseline, and generated logistic regression models to find the adjusted relative risk (RR) of their co-occurrence, adjusting for patient-level factors and three potential medical causes of dyspnea (chronic obstructive pulmonary disease/emphysema/asthma, congestive heart failure, and obesity). We modeled the simultaneous development and the simultaneous resolution of dyspnea and pain between baseline and 2 years.
Participants with dyspnea had considerably higher prevalence of pain than those without (64 vs. 18%). In fully adjusted models, participants with any of the types of pain were substantially more likely to report dyspnea than those without these types of pain (high pain interference: relative risk [RR], 1.99; 95% confidence interval [CI], 1.92-2.07; chest pain: RR, 2.11; 95% CI, 2.04-2.18; back pain: RR, 1.76; 95% CI, 1.71-1.82; and arthritis pain: RR, 1.49; 95% CI, 1.44-1.54). The relative risks of dyspnea developing or resolving at 2 years were greatly increased (RRs of 1.5 - 4) if pain also developed or resolved.
Pain and dyspnea commonly occurred, developed, and resolved together. Most older adults with dyspnea also reported pain. Medical conditions typically assumed to cause dyspnea did not account for this association. The most plausible explanation for the co-occurrence is physical deconditioning.
实验和神经影像学研究表明，呼吸困难与疼痛之间存在密切关联。尚未在社区样本中对这些症状的共现情况进行研究。
我们试图通过自我报告来确定一大群医疗保险受益人中疼痛与呼吸困难的共现情况。
我们分析了2010年和2012年对266,000名医疗保险管理式医疗受益人进行调查的数据。呼吸困难通过汇总三个关于呼吸急促的问题（休息时、步行一个街区时和爬楼梯时）来定义。疼痛通过四个关于疼痛干扰、胸痛、背痛和关节炎疼痛的问题来测量。所有测量结果都分为高或低/无。我们计算了基线时疼痛与呼吸困难的共现情况，并生成逻辑回归模型以找出它们共现的调整后相对风险（RR），同时对患者层面的因素以及呼吸困难的三个潜在医学原因（慢性阻塞性肺疾病/肺气肿/哮喘、充血性心力衰竭和肥胖）进行了调整。我们对基线和2年之间呼吸困难和疼痛的同时发生和同时缓解情况进行了建模。
有呼吸困难的参与者疼痛患病率明显高于无呼吸困难者（64%对18%）。在完全调整的模型中，患有任何一种疼痛类型的参与者报告呼吸困难的可能性显著高于没有这些疼痛类型的参与者（高疼痛干扰：相对风险[RR]，1.99；95%置信区间[CI]，1.92 - 2.07；胸痛：RR，2.11；95%CI，2.04 - 2.18；背痛：RR，1.76；95%CI，1.71 - 1.82；关节炎疼痛：RR，1.49；95%CI，1.44 - 1.54）。如果疼痛也发生或缓解，2年时呼吸困难发生或缓解的相对风险会大幅增加（RR为1.5 - 4）。
疼痛和呼吸困难通常同时发生、发展和缓解。大多数有呼吸困难的老年人也报告有疼痛。通常被认为导致呼吸困难的医学状况并不能解释这种关联。这种共现最合理的解释是身体机能下降。
