title: Heart failure: the hidden problem of pain.
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>or=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.
authors.affiliation: School of Nursing, California State University, Long Beach, Long Beach, California 90840-1006, USA. jgoebel@csulb.edu
authors.forename: Joy R
authors.initials: JR
authors.lastname: Goebel
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shugarman
authors.forename: Steve M
authors.initials: SM
authors.lastname: Asch
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Andy B
authors.initials: AB
authors.lastname: Lanto
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Evangelista
authors.forename: Adeline M
authors.initials: AM
authors.lastname: Nyamathi
authors.forename: Sally L
authors.initials: SL
authors.lastname: Maliski
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care