title: Pain in patients with COPD: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically investigate the prevalence of pain, factors related with pain and pain management interventions in patients with chronic obstructive pulmonary disease (COPD).
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  PubMed (MEDLINE), EMBASE, CINAHL and PsychINFO from 1966 to December 2013. Studies were included if they presented clinical data on pain or symptom burden in patients with COPD, or pain as a domain of quality of life (QoL). All types of study designs were included.
  
  
  RESULTS
  Of the 1571 articles that were identified, 39 met the inclusion criteria and were included in this review. Fourteen studies focused on pain and symptom burden (including pain) in patients with COPD and 25 studies focused on QoL using a questionnaire that included a separate pain domain. Reported pain prevalence in high-quality studies ranged from 32 to 60%. Included studies report that pain is more prevalent in patients with COPD compared to participants from the general population. Comorbidity, nutritional status, QoL and several symptoms were related to pain. None of the included studies reported a significant relationship between lung function and pain prevalence or severity. However, studies investigating pain in patients with moderate COPD reported higher pain prevalence compared to studies in patients with severe of very severe COPD.
  
  
  CONCLUSIONS
  Although literature on this topic is limited and shows substantial heterogeneity, pain seems to be a significant problem in patients with COPD and is related to several other symptoms, comorbidity and QoL. Data synthesis suggests that pain is more prevalent in patients with moderate COPD compared to patients with severe or very severe COPD. Further research is needed and should focus on determining a more accurate pain prevalence, investigating the relationship between pain prevalence, disease severity and comorbidity and explore implementation and efficacy of pain management interventions in patients with COPD.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Eléonore F
authors.initials: EF
authors.lastname: van Dam van Isselt
authors.affiliation: Pulmonary Department, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Karin H
authors.initials: KH
authors.lastname: Groenewegen-Sipkema
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands Pulmonary Department, Deventer Hospital, Deventer, The Netherlands Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Monica
authors.initials: M
authors.lastname: Spruit-van Eijk
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Chavannes
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Margot W M
authors.initials: MW
authors.lastname: de Waal
authors.affiliation: Department of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
mesh_terms: D006801:Humans; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D059408:Pain Management; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*
keywords: PAIN MANAGEMENT; PRIMARY CARE; RESPIRATORY MEDICINE (see Thoracic Medicine)