title: Pain is a common problem affecting clinical outcomes in adults with cystic fibrosis.
abstract: BACKGROUND
  As the cystic fibrosis (CF) population has aged, many chronic health problems have emerged, including diabetes mellitus and osteoporosis. Previous studies have suggested that pain is common in patients with CF; however, little is known about the factors associated with it or its impact on clinical outcomes. We hypothesized that pain is common, is associated with psychologic distress, and adversely affects clinical outcomes.
  
  
  METHODS
  From February 1, 2008, to April 3, 2008, adults with CF from Johns Hopkins Hospital were surveyed about their pain. Outcomes were assessed for 12 months following survey completion. Bivariate analyses were performed using Wilcoxon log rank, Kruskal-Wallis tests, and Spearman correlations. Logistic regression models and Cox proportional hazard models were used to analyze clinical outcomes.
  
  
  RESULTS
  Eighty-three patients (61%) completed the survey. Eighty-two percent of patients reported pain within the past month, the most common sites being the head, sinuses, back, and chest. Pain frequently interfered with general activities (41.9%), mood (56.8%), and work (47.3%). Symptoms of depression and anxiety, as well as lower quality-of-life (QOL) scores, were associated with the presence of pain (P < .05 for each). The risk of pulmonary exacerbations was increased in patients with higher levels of pain, even after adjusting for FEV(1) and age (OR = 1.65; P = .038; 95% CI, 1.03-2.64). Additionally, the risk of death was higher in patients with higher average pain scores (HR = 2.28; P = .008; 95% CI = 1.2-4.2).
  
  
  CONCLUSIONS
  Pain is common in adults with CF, interferes with activities, and is associated with lower QOL and an increased risk of both exacerbations and death.
authors.affiliation: Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hayes
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Myron
authors.initials: M
authors.lastname: Yaster
authors.affiliation: Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riekert
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Kristen
authors.initials: K
authors.lastname: Nelson McMillan
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: White
authors.affiliation: Department of Pediatrics, Division of Pulmonary Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mogayzel
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: nlechtz@jhmi.edu.
authors.forename: Noah
authors.initials: N
authors.lastname: Lechtzin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D004813:Epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011788:Quality of Life; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D055815:Young Adult