Bentsen Signe B, Miaskowski Christine, Cooper Bruce A, Christensen Vivi L, Henriksen Anne H, Holm Are M, Rustøen Tone
Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Department of Physiological Nursing, University of California, San Francisco, CA, USA.
Int J Chron Obstruct Pulmon Dis. 2018 Mar 6;13:801-811. doi: 10.2147/COPD.S150114. eCollection 2018.
Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients.
The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL).
A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity.
Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the "high probability of pain" group, while 29% were in the "moderate probability of pain" group. For the worst pain severity, 37% were in the "moderate pain" and 39% were in the "mild pain" groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale.
Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.
很少有研究探讨慢性阻塞性肺疾病（COPD）患者疼痛体验的变化以及这些患者疼痛的预测因素。
本研究的目的是检查是否可以根据12个月内疼痛发生情况和严重程度的变化识别出不同组的COPD患者，并评估这些组在人口统计学、临床和疼痛特征以及健康相关生活质量（HRQoL）方面是否存在差异。
对267例极重度COPD患者进行了一项纵向研究。他们的平均年龄为63岁，53%为女性。患者在入组时以及随访3、6、9和12个月时完成了包括人口统计学和临床变量、简明疼痛问卷以及圣乔治呼吸问卷在内的问卷调查。此外，还进行了肺功能测定和6分钟步行试验。采用潜在类别分析根据疼痛发生情况和最严重疼痛程度识别出具有不同疼痛特征的患者亚组。
大多数患者（77%）报告在12个月内有疼痛发生。其中，48%属于“高疼痛概率”组，而29%属于“中等疼痛概率”组。对于最严重疼痛程度，37%属于“中度疼痛”组，39%属于“轻度疼痛”组。女性以及体重指数较高、合并症数量较多和受教育程度较低的患者属于疼痛组。疼痛程度较高组的患者报告的疼痛干扰评分较高、疼痛部位数量较多且呼吸道症状较多。除症状子量表外，各组之间在HRQoL方面几乎没有差异。
COPD患者需要全面的疼痛管理。临床医生可以利用这些信息识别出持续性疼痛风险较高的患者。
