Heart Failure

The Hidden Problem of Pain

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

Research output: Contribution to journalArticle

48 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)698-707
Number of pages10
JournalJournal of Pain and Symptom Management
Volume38
Issue number5
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Heart Failure
Pain
Psychology
Dyspnea
Linear Models
Equipment and Supplies
Veterans
Anxiety Disorders
Health Status
Multicenter Studies
Fatigue
Anxiety
Quality of Life
Demography
Depression
Morbidity

Keywords

  • BPI
  • conceptual framework
  • Heart failure
  • palliative care
  • PHQ-2
  • social well-being
  • social work
  • spiritual well-being
  • symptoms
  • total pain

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Goebel, J. R., Doering, L. V., Shugarman, L. R., Asch, S. M., Sherbourne, C. D., Lanto, A. B., ... Lorenz, K. A. (2009). Heart Failure: The Hidden Problem of Pain. Journal of Pain and Symptom Management, 38(5), 698-707. https://doi.org/10.1016/j.jpainsymman.2009.04.022

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; Nyamathi, Adeline M.; Maliski, Sally L.; Lorenz, Karl A.

In: Journal of Pain and Symptom Management, Vol. 38, No. 5, 01.01.2009, p. 698-707.

Research output: Contribution to journalArticle

Goebel, JR, Doering, LV, Shugarman, LR, Asch, SM, Sherbourne, CD, Lanto, AB, Evangelista, L, Nyamathi, AM, Maliski, SL & Lorenz, KA 2009, 'Heart Failure: The Hidden Problem of Pain', Journal of Pain and Symptom Management, vol. 38, no. 5, pp. 698-707. https://doi.org/10.1016/j.jpainsymman.2009.04.022
Goebel JR, Doering LV, Shugarman LR, Asch SM, Sherbourne CD, Lanto AB et al. Heart Failure: The Hidden Problem of Pain. Journal of Pain and Symptom Management. 2009 Jan 1;38(5):698-707. https://doi.org/10.1016/j.jpainsymman.2009.04.022
Goebel, Joy R. ; Doering, Lynn V. ; Shugarman, Lisa R. ; Asch, Steve M. ; Sherbourne, Cathy D. ; Lanto, Andy B. ; Evangelista, Lorraine ; Nyamathi, Adeline M. ; Maliski, Sally L. ; Lorenz, Karl A. / Heart Failure : The Hidden Problem of Pain. In: Journal of Pain and Symptom Management. 2009 ; Vol. 38, No. 5. pp. 698-707.
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