title: Investigating pain in heart failure patients: the pain assessment, incidence, and nature in heart failure (PAIN-HF) study.
abstract: BACKGROUND
  Patients with advanced heart failure (HF) have high rates of pain and other symptoms that diminish quality of life. We know little about the characteristics and correlates of pain in patients with advanced HF.
  
  
  RESULTS
  We identified pain prevalence, location, character, severity, frequency, and correlates in 347 outpatients with advanced HF enrolled from hospices and clinics. We evaluated the correlation of pain with HF-related quality of life, mortality, symptoms and health problems, and current treatments for pain. Pain at any site was reported by 293 patients (84.4%), and 138 (39.5%) reported pain at more than one site. The most common site of pain was the legs below the knees (32.3% of subjects). Pain interfered with activity for 70% of patients. Pain was "severe" or "very severe" for 28.6% of subjects with chest pain, and for 38.9% of those with other sites of pain. The only medication reported to provide pain relief was opioids, prescribed for 34.1% of subjects (P = .001). The strongest predictors of pain were degenerative joint disease (DJD) (odds ratio [OR] 14.95, 95% confidence interval [CI] 3.9-56.0; P < .001), other arthritis (OR 2.8, 95% CI 1.20-6.62; P = .017), shortness of breath (OR 3.27, 95% CI 1.47-7.28; P = .004), and angina pectoris (OR 3.38, 95% CI 1.30-8.81; P = .013).
  
  
  CONCLUSIONS
  Pain occurred at multiple sites in patients with advanced HF. Pain correlated with DJD or other arthritis, shortness of breath, and angina. Only opioid analgesics provided relief of pain. Future research should evaluate the etiology of and interventions to manage pain in patients with HF.
authors.affiliation: Patient-Centered Education and Research, Salt Lake City, Utah, USA. sgoodlin@patient-centered.org
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Goodlin
authors.forename: Sue
authors.initials: S
authors.lastname: Wingate
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.forename: Janet
authors.initials: J
authors.lastname: Houser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kwon
authors.forename: Jun
authors.initials: J
authors.lastname: Chiong
authors.forename: C Porter
authors.initials: CP
authors.lastname: Storey
authors.forename: Timothy
authors.initials: T
authors.lastname: Quill
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
mesh_terms: D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D010147:Pain Measurement; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology