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

53 Scopus citations

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

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., Evangelista, L., Nyamathi, A. M., Maliski, S. L., & 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