title: Chronic pain in cystic fibrosis.
abstract: OBJECTIVE
  The objective of this study was to examine the incidence and therapy of chronic pain in a group of older patients with cystic fibrosis (CF).
  
  
  METHODS
  We identified two groups of patients followed at the CF Center at Children's Hospital (Boston); the first group consisted of all patients above the age of 5 years who died between 1984 and 1993, and the second was a cohort of 23 additional CF patients who had been referred to the Pain Treatment Service.
  
  
  METHODS
  Medical charts were reviewed for the etiology and therapy of all pain episodes requiring medical intervention.
  
  
  RESULTS
  The incidence of chronic pain in this population increased sharply in the last 6 months of life. Headaches (55% of patients) and chest pain (65%) were frequently reported, although back pain (19%), abdominal pain (19%), and limb pain (16%) were also reported. In patients with headache, the main etiologies were hypercarbia or hypoxia, migraine, and sinusitis. The majority of chest pain was musculoskeletal, with pleuritis, pneumothorax, and rib fracture also reported as the cause of chest pain.
  
  
  METHODS
  A variety of nonpharmacological and pharmacological therapies were reported. Forty-one patients (53%) had pain severe enough to require opioid treatment, and 10 patients (13%) received opioids for more than 3 months. In eight patients with more severe pain, regional analgesia was found to be particularly effective.
  
  
  CONCLUSIONS
  Chronic pain is a common problem in CF, particularly as the patient population ages. When administered with caution, opioids have proven to be effective and safe in this population; regional anesthesia can be used to preserve pulmonary toilet while adequately treating severe pain.
authors.affiliation: Department of Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ravilly
authors.forename: W
authors.initials: W
authors.lastname: Robinson
authors.forename: S
authors.initials: S
authors.lastname: Suresh
authors.forename: M E
authors.initials: ME
authors.lastname: Wohl
authors.forename: C B
authors.initials: CB
authors.lastname: Berde
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001900:Boston / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D010146:Pain / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics